Treatment recommendations in children and adolescents with lupus nephritis

Among the organ manifestations of systemic lupus erythematosus (SLE), involvement of the kidneys plays a key role in morbidity and mortality. Early diagnosis and appropriate treatment of lupus nephritis (LN) is therefore very important. On the basis of the current literature and the experience gathered by members of the SLE working group of the German Society for Pediatric Nephrology (APN), the following article presents consensus recommendations for treating LN in children and adolescents. Depending on the severity of the initial organ involvement (extent of proteinuria, kidney histology) and the initial response to treatment, prednisolone is supplemented, where appropriate, by mycophenolate mofetil, azathioprine, cyclophosphamide or cyclosporine A. In addition to consistent antihypertensive and nephroprotective treatment, adjuvant therapy should attempt to avoid possible side effects such as gonad toxicity and growth disorder. We believe that future prospective recording of the LN patients treated in line with these consensus recommendations can help treatment guidelines to be drawn up for this disease.