Ⅴ型狼疮肾炎的诊断与治疗

系统性红斑狼疮(SLE)是最常见的自身免疫性疾病，狼疮肾炎(LN)是SLE患者临床较常见且严重的并发症，至少50%以上的SLE患者临床上有肾脏受累的证据。Ⅴ型狼疮肾炎，又称膜性狼疮肾炎，在肾活检确诊LN中的比例为8%～20%。目前Ⅴ型LN的治疗尚无统一方案。所有Ⅴ型LN患者都应尽早开展以减少蛋白尿、控制血压、降低血脂、抗凝治疗为主的非免疫抑制治疗，其中肾素-血管紧张素系统阻断剂起重要作用。伴有严重蛋白尿、肾功能损害或非免疫抑制治疗无效的患者，需接受免疫抑制治疗，具体方案为糖皮质激素联合硫唑嘌呤或烷化剂或钙调磷酸酶抑制剂或吗替麦考酚酯。免疫抑制治疗的方案选择及疗效仍需大样本临床研究进一步证实。

Diagnosis,differential diagnosis and treatment of class V lupus nephritis

Systemic lupus erythematosus (SLE) is the most common autoimmune disease. Kidney involvement is one of the most frequent and serious organ manifestations of SLE. At least over 50% patients with SLE have renal involvement. Class V lupus nephritis, also called membranous lupus nephritis, accounts for approximately 8%-20% of lupus nephritis as confirmed by renal biopsy. Currently, evidence-based recommendations for treatment of calss V lupus nephritis are lacking. Non-immunosuppressive treatment should be instituted early in all patients mainly for decreasing proteinuria, controlling blood pressure, lowering serum lipids, and anti-coagulation, among which blockade of the renin-angiotensin system with ACE inhibitors or ARBs is an important consideration. If class V lupus nephritis is associated with clinically relevant severe proteinuria, renal insufficiency, or failure to respond to the non-immunosuppressive treatment, immunosuppressive treatment is indicated, including glucocorticoids combined with azathioprine, alkylating agents, calcineurin inhibitors, or mycophenolate mofitil. Large-scale clinical trials are still needed for the options and efficacy of immunosuppressive regimens.