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Dialyse aktuell 2020; 24(05/06): 222-232
DOI: 10.1055/a-1121-5151
Schwerpunkt
Nephrologie
© Georg Thieme Verlag Stuttgart · New York

Lupusnephritis

Hintergründe und Grundlagen
Peter Oelzner
1   Klinik für Innere Medizin III, Funktionsbereich Rheumatologie und Osteologie, Universitätsklinikum Jena
,
Kerstin Amann
2   Abteilung Nephropathologie, Universitätsklinikum Erlangen
› Author Affiliations
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Publication History

Publication Date:
23 July 2020 (online)

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ZUSAMMENFASSUNG

Die Lupusnephritis (LN) als prognosebestimmende Manifestation des systemischen Lupus erythematodes betrifft ca. 50 % der Patienten. Die Nierenbiopsie ermöglicht auf Basis der Klassifikation und der Bestimmung von Aktivitäts- und Chronizitätsindex eine gezielte Therapie und gibt wichtige Informationen zur Prognose. Bei der häufigsten Form der LN, der proliferativen LN, auch in Kombination mit einer membranösen LN, erfolgt eine Remissionsinduktion mit einer intravenösen (i. v.) Low-Dose-Cyclophosphamid-Therapie (6-mal 500 mg) oder mit Mycophenolatmofetil (MMF) kombiniert mit initial hoch dosierten Glukokortikoiden (GK), gefolgt von einer Remissionserhaltung mit Azathioprin oder MMF. Wichtige Therapieziele sind möglichst komplette renale Remission, gekennzeichnet durch den Erhalt einer zumindest annährend normalen Nierenfunktion, und eine weitgehende Reduktion der Proteinurie. Eine komplette Remission wird aktuell nach 2 Jahren bei 40–60 % der Patienten erreicht. Neuere Therapieansätze zielen neben einer verbesserten Effektivität auf eine geringere Toxizität und weitestgehende Reduktion von GK und umfassen den Einsatz von Biologika sowie die Multitarget-Therapie mit konventionellen Immunsuppressiva.

 

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