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Systematic review and meta-analysis of randomised trials and cohort studies of mycophenolate mofetil in lupus nephritis

DOI: 10.1186/ar2093

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The prevalence of systemic lupus erythematosus (SLE) varies with age, gender, and ethnicity, and the highest rates occur in young adult women, particularly of Afro-Caribbean origin, who are in peak childbearing years [1-4]. Nephritis complicates SLE in a significant minority of patients and is associated with renal failure and increased mortality. The tendency for people of Afro-Caribbean origin to have a worse prognosis may be due, at least in part, to poor socio-economic status [5]. In the 1950s, patients with class IV nephritis rarely lived longer than 5 years, whereas now more than 80% survive with good renal function for more than 10 years [6].The World Health Organization (WHO) classification for lupus nephritis is based on the histological appearance, with progressive changes to the glomerulus and tubulo-interstitium with increasing severity (Additional file 1). Milder disease (WHO classes II and IIIa) affects approximately 35% to 50%, whereas more serious classes IIIb, IV, and V affect 45% to 60% [7]. A significant minority of patients with class III disease (focal segmental proliferative glomerulonephritis) show worsening renal function and may progress to class IV lupus nephritis. Class IV (diffuse proliferative glomerulonephritis) usually presents with clinical evidence of renal disease, including oedema, hypertension, sediment, and worsening renal function with proteinuria. Class V (diffuse membranous glomerulonephritis) involves patients with laboratory and clinical features of nephrotic syndrome.The aim of treatment is first to stop disease progression (induction phase) and then prevent recurrence (maintenance) while minimising the adverse effects. More specifically with lupus nephritis, the aims of treatment are to reduce the risk of end-stage renal disease, reduce renal and extra-renal lupus activity or symptoms, and reduce the mortality risk.Treatment with immunosuppressive therapy is better than prednisolone monotherapy at preserving renal function


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