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Prediction of prognosis and renal outcome in lupus nephritis

Lupus nephritis (LN) is a severe manifestation of SLE, characterised by subendothelial and/or subepithelial immune complex depositions in the afflicted kidney, resulting in extensive injury and nephron loss during the acute phase and eventually chronic irreversible damage and renal function impairme...

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Autores principales: Parodis, Ioannis, Tamirou, Farah, Houssiau, Frédéric A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7046967/
https://www.ncbi.nlm.nih.gov/pubmed/32153796
http://dx.doi.org/10.1136/lupus-2020-000389
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author Parodis, Ioannis
Tamirou, Farah
Houssiau, Frédéric A
author_facet Parodis, Ioannis
Tamirou, Farah
Houssiau, Frédéric A
author_sort Parodis, Ioannis
collection PubMed
description Lupus nephritis (LN) is a severe manifestation of SLE, characterised by subendothelial and/or subepithelial immune complex depositions in the afflicted kidney, resulting in extensive injury and nephron loss during the acute phase and eventually chronic irreversible damage and renal function impairment if not treated effectively. The therapeutic management of LN has improved during the last decades, but the imperative need for consensual outcome measures remains. In order to design trials with success potentiality, it is important to define clinically important short-term and long-term targets of therapeutic and non-therapeutic intervention. While it is known that early response to treatment is coupled with favourable renal outcomes, early predictors of renal function impairment are lacking. The information gleaned from kidney biopsies may provide important insights in this direction. Alas, baseline clinical and histopathological information has not been shown to be informative. By contrast, accumulating evidence of pronounced discrepancies between clinical and histopathological outcomes after the initial phase of immunosuppression has prompted investigations of the potential usefulness of per-protocol repeat kidney biopsies as an integral part of treatment evaluation, including patients showing adequate clinical response. This approach appears to have merit. Hopefully, clinical, molecular or genetic markers that reliably reflect kidney histopathology and portend the long-term prognosis will be identified. Novel non-invasive imaging methods and employment of the evolving artificial intelligence in pattern recognition may also be helpful towards these goals. The molecular and cellular characterisation of SLE and LN will hopefully result in novel therapeutic modalities, maybe new taxonomy perspectives, and ultimately personalised management.
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spelling pubmed-70469672020-03-09 Prediction of prognosis and renal outcome in lupus nephritis Parodis, Ioannis Tamirou, Farah Houssiau, Frédéric A Lupus Sci Med Review Lupus nephritis (LN) is a severe manifestation of SLE, characterised by subendothelial and/or subepithelial immune complex depositions in the afflicted kidney, resulting in extensive injury and nephron loss during the acute phase and eventually chronic irreversible damage and renal function impairment if not treated effectively. The therapeutic management of LN has improved during the last decades, but the imperative need for consensual outcome measures remains. In order to design trials with success potentiality, it is important to define clinically important short-term and long-term targets of therapeutic and non-therapeutic intervention. While it is known that early response to treatment is coupled with favourable renal outcomes, early predictors of renal function impairment are lacking. The information gleaned from kidney biopsies may provide important insights in this direction. Alas, baseline clinical and histopathological information has not been shown to be informative. By contrast, accumulating evidence of pronounced discrepancies between clinical and histopathological outcomes after the initial phase of immunosuppression has prompted investigations of the potential usefulness of per-protocol repeat kidney biopsies as an integral part of treatment evaluation, including patients showing adequate clinical response. This approach appears to have merit. Hopefully, clinical, molecular or genetic markers that reliably reflect kidney histopathology and portend the long-term prognosis will be identified. Novel non-invasive imaging methods and employment of the evolving artificial intelligence in pattern recognition may also be helpful towards these goals. The molecular and cellular characterisation of SLE and LN will hopefully result in novel therapeutic modalities, maybe new taxonomy perspectives, and ultimately personalised management. BMJ Publishing Group 2020-02-18 /pmc/articles/PMC7046967/ /pubmed/32153796 http://dx.doi.org/10.1136/lupus-2020-000389 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Review
Parodis, Ioannis
Tamirou, Farah
Houssiau, Frédéric A
Prediction of prognosis and renal outcome in lupus nephritis
title Prediction of prognosis and renal outcome in lupus nephritis
title_full Prediction of prognosis and renal outcome in lupus nephritis
title_fullStr Prediction of prognosis and renal outcome in lupus nephritis
title_full_unstemmed Prediction of prognosis and renal outcome in lupus nephritis
title_short Prediction of prognosis and renal outcome in lupus nephritis
title_sort prediction of prognosis and renal outcome in lupus nephritis
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7046967/
https://www.ncbi.nlm.nih.gov/pubmed/32153796
http://dx.doi.org/10.1136/lupus-2020-000389
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