Egyptian evidence-based consensus on clinical practice recommendations for the management of lupus nephritis

Author:

El Miedany YasserORCID,Kamel Nadia SalahORCID,Abu-Zaid Mohammed HassanORCID,El Hadidi Khaled,Mahmoud Geilan AbdelmoneimORCID,Sarhan Eman,El Gaafary MahaORCID,Abdel-Nasser AhmedORCID,Abualfadl Esam M.ORCID,Azim Atef Abdel,Fathi Nihal Ahmed,Mokbel Abir,Hassan WaleedORCID,Tabra Samar Abd AlhamedORCID,Eissa MervatORCID,Mortada MohamedORCID,Fouad Nermeen AhmedORCID,Elnemr RehabORCID,Mansour Ahmed EzzatORCID,Elaraby Ismail,Medhat Basma M.ORCID,Mohamed Sally S.ORCID,Abdelradi Eman RagabORCID,Ibrahim Rehab Ali,Saber SallyORCID

Abstract

Abstract Background Lupus nephritis (LN) affects a substantial number of the patients living with Systemic lupus erythematosus (SLE), representing a major cause of morbidity and mortality. Patients with lupus nephritis should be referred to a lupus nephritis expert who can confirm the diagnosis, assess the level of disease activity, and offer guidance on treatment and monitoring of the disease, as well as its consequences and side effects. The aim of this guideline was to develop recommendations for the management of adult lupus patients, including lupus nephritis diagnosis, assessment, and monitoring. Nineteen key clinical questions were identified by scientific committee according to the Patient/Population, Intervention, Comparison, Outcomes and Timing (PICOT) approach. Literature review team performed a systematic review to summarize evidence advocating the benefits and harms of available pharmacologic and nonpharmacologic therapies for LN. Subsequently, recommendations were formulated. The level of evidence was determined for each section using the Oxford Centre for Evidence-based Medicine (CEBM) system. A 2-round Delphi process was conducted with 24 experts. All rounds were conducted online. A consensus was achieved on the direction and the strength of the recommendations. Results An online questionnaire was sent to an expert panel who participated in the two rounds (response rate 100%). At the end of round 2, a total of 19 recommendation items, categorized into 11 sections to address the main LN categories, were obtained. The percentage of those who agreed with the recommendations (ranks 7–9) ranged from 90.5 to 100%. The phrasing of all 19 clinical standards identified by the scientific committee was agreed upon (i.e., 75% of respondents strongly agreed or agreed). Conclusion These recommendations provide an updated consensus on the pharmacological treatment of lupus nephritis and strategies to reach optimal treat to target outcomes in common clinical scenarios, based on a combination of evidence and expert opinion. Best treatment decisions should be tailored to each individual patient situation.

Publisher

Springer Science and Business Media LLC

Subject

Industrial and Manufacturing Engineering,Materials Science (miscellaneous),Business and International Management,General Earth and Planetary Sciences,General Environmental Science

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