SLE Nefriti ve Güncel Tedaviler

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SLE Nephritis and Current Therapies
Yayın Yılı: 
2007
Cilt: 
16
Sayı: 
4
Sayfa Aralığı:: 
159-168
Yayın Dili: 
Türkçe
Anahtar Kelimeler: 
Abstract (2. Language): 
Lupus nephritis is one of the most serious manifestations of systemic lupus erythematosus (SLE}. Renal involvement is common in SLE, but renal failure rarely occurs. Estimates of the prevalence of clinical renal involvement in persons with SLE range from 30% to 90% in published studies. The true prevalence of clinical lupus nephritis İs probably around 50%. The classification of lupus nephritis was revised by the international Society of Pathology/Renal Pathology Society (ISN/RPS) in 2003 and is based on light microscopy, immunofluorescence, and electron microscopy findings from renal biopsy specimens. This is based on earlier classifications by the World Health Organization (WHO) in 1974 and 1982. Therapies for specific types of lupus nephritis based on renal pathology. The principal goal of therapy is to normalize renal function or, at least, to prevent the progressive loss of renal function. Therapy differs depending on the pathologic lesion. Corticosteroids are used if the patient has clinically significant renal disease. Immunosuppressive agents, particularly cyclophosphamide, azathioprine, or mycophenolate mofetil are used, if the patient has aggressive proliferative renal lesions because they improve the renal outcome. Other modalities that have been evaluated include intravenous immune globulin, high-dose chemotherapy with stem cell transplantation, other chemotherapeutic agents, monoclonal antibody therapy, cyclosporine, immunoadsorption, complement inhibitors, toleragens.
Özet (Orjinal Dil): 
Lupus nefrit i sistemik lupus eritamatozusun en önemli klinik görünümlerinden biridir. Renal tutulum SLE'de sıktır, fakat böbrek yetmezliği nadiren görülür. SLE'li hastalarda klinik böbrek tutulumu prevalans! yayımlanmış çalışmalarda %30-90 olarak tahmin edilmektedir. Klinik lupus nefritinin gerçek prevalansı %50 civarındadır. Lupus nefriti sınıflaması Uluslararası Patoloji/Renal Patoloji Derneği (International Society of Pathology/Renal Pathology Society ISN/RPSI tarafından 2003'te tekrar gözden geçirilmiştir ve ışık mik-roskopisi, immünofloresan ve elektron mikroskopisinde böbrek biyopsi materyallerinden elde edilen bulgulara dayanır. Bu sınıflama, 1974 te ve 1982'de Dünya Sağlık Örgütü'nün (DSÖ) yaptığı eski sınıflamaya dayandırılmıştır. Lupus nefriti spesifik tiplerine göre yapılan tedavilerde böbrek patolojisi temel alınır. Tedavinin amacı böbrek fonksiyonlarını normalleştirmek veya en azından ilerleyici böbrek fonksiyon kaybını önlemektir. Eğer hastalarda klinik olarak belirgin böbrek hastalığı varsa kortikosteroidler kullanılır. Immünosupre-sif ajanlar Özellikle sikiofosfamid, azatioprin veya mikofenolat mofe-til, eğer hastalarda agresif proliferate böbrek lezyonları varsa, renal sonuçları düzelttiği için kullanılır. Diğer tedavi yöntemleri arasında intravenöz immunoglobulin, kök hücre tranplantasyonu ile yüksek doz kemoterapi, diğer kemoterapotik ajanlar, monoklonal antikor tedavisi, siklosporin, immünoadsorbsiyon, kompleman inhibitörleri, tolerajenler yeralmaktadır.
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