Dr. Cora Lim
Discussion on latest management of lupus nephritis
(Part 2)
Let us continue to discuss the latest management procedure in treating people with lupus nephritis (LN).
After the approval by the European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) Executive Communities, the convenors invited a panel of 11 rheumatiologists, 11 nephrologist, 1 nephropathologist, 1 pediatric rheumatologist, 1 pediatric inphrologist, 1 allied health professional, and 2 patient representatives.
The EULAR panel standardized the operating procedures that are to be followed and the Appraisal of Guidelines Research and Evaluation Instrument was used. The methodology used is Delphi-based. This led to questions for systematic literature review (SLR) undertaken by three (3) fellows.
Online medical resource PubMed was searched using specific index terms and obtained items were evaluated based on the title, abstract, and/or full text. As this is an update of the 2012 recommendations, the experts focused on all English-language publications published between January 2012 and December 2018.
In turn, the results of the search were then analyzed, summarized, distributed to those concerned and discussed on a meeting of the panel on May 2019.
It was revealed that in the previous reports, recommendations were reappraised and revised accordingly. The final level of evidence (LoE; scale: 1-4) and grading of recommendations (GoRs; scale: A (highest) to D (lowest)), according to the Oxford Center for Evidence Based Medicine definitions, considered the total body of evidence. Each member of the panel was then asked to rate their level of agreement (LOA) for each statement on a 0-10 rating scale (10 being full agreement), based on both the research evidence presented and their own clinical expertise.
In the final voting, Task Force members had the opportunity’ to express their potential disagreement for a particular statement, however omission of statements with less consensus were not considered as necessary.
The methods and results of the SLR will be published separately, as revealed by the panel.
Despite an improved prognosis over the last decades, LN poses therapeutic challenges and is linked to mortality and healthcare costs.
The disease‘s nature, (involvement of the kidneys in the context of a systemic autoimmune disease) needs a multidisciplinary approach by rheumatologists and nephrologists, following histological confirmation increased morbidity, and assessment of LN by a nephropathologist.
In this light, the management or periodic evaluation of these patients with expertise is recommended.
When making decisions on the management or therapy for LN, it requires that the patient is adequately informed about the disease and the therapeutic options that are available.
Next week we will be discussing the recommendations reached by the panel of experts revising the standards of management of LN in patients who are suffering from this disease.