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Lupus nephritis is a relevant source of morbidity and mortality in patients with systemic lupus erythematosus. The standard therapy of remission induction in severe lupus nephritis is based on the use of monthly intravenous cyclophosphamide. Recent data have established that the maintenance of remission in lupus nephritis can be achieved with azathioprine or mycophenolate mofetil, with less adverse effects than quarterly intravenous cyclophosphamide. In recent years, a number of controlled randomized clinical trials have been published, opening new therapeutic options in the induction of remission in lupus nephritis, such as less aggressive regimens of intravenous cyclophosphamide or mycophenolate mofetil. Further studies are needed for establishing the optimal therapy of lupus nephritis patients.
Key words:
Lupus nephritis
Mycophenolate mofetil
Cyclophosphamide
Systemic lupus erythematosus
La nefritis lúpica es una causa importante de morbilidad y mortalidad en los pacientes con lupus eritematoso sistémico. El tratamiento convencional de inducción de remisión en la nefritis lúpica grave se basa en la utilización de ciclofosfamida intravenosa mensual. Datos recientes han puesto de manifiesto que el mantenimiento de remisión de la nefritis lúpica se consigue con un menor número de efectos secundarios utilizando azatioprina o micofenolato, frente a la administración trimestral de ciclofosfamida intravenosa. En los últimos años se han publicado ensayos clínicos controlados y aleatorizados que plantean nuevas modalidades terapéuticas en la inducción de remisión en la nefritis lúpica, como son la utilización de pautas menos agresivas de ciclofosfamida intravenosa o el uso de micofenolato mofetilo. Se necesitan más estudios para establecer el tratamiento óptimo de los pacientes con nefritis lúpica grave.
Palabras clave:
Nefritis lúpica
Micofenolato mofetilo
Ciclofosfamida
Lupus eritematoso sistémico
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