For Internists and Critical care physicians

2. Treatment Decisions in SLE Ahmed Elshebiny University of Menoufyia

4. Treatment Plan General measures

9. Modified Classification of LN (Kumar and Clarks’s , Clinical Medicine 2009) Progressive renal failure Advanced sclerosing VI 10-20% of cases Good prognosis Membranous V Progression to NS, HTN, and Renal imp. Most common and most severe Diffuse LN IV 10-20% of cases Hematuria and proteinuria Focal LN III Mild renal disease Mesangial proliferative LN II A symptomatic Minimal mesangial LN I Clinical Histological Class

12. Biopsy spicimens

13. Biopsy specimens

16. Treatment of Lupus Nephritis base on biopsy Class Prepare for hemo which is better than peritoneal Arrange for renal Tx, treat extra-renal lupus VI Prednisone for 1-3 months followed by low dose for 1-2 years Azathioprin , chlorambucil, cyclophosphamide or MMF may decrease proteinuria V IV Prednisolone 1mg/kg/d for 1 month then taper depending on the clinical response to 5-10 mg for 2-2.5 years or Pulses for 3 days in severly ill add imunosupressive when indicated, adjust immunosupressine with cbc III 20-40 for 1 -3 months II Non specific I Treatment Clasas

22. Cutaneous manifestations of Lupus

31. Ciclosporin

32. Rutiximab

34. Hydroxychloroquin

35. References

36. THANK YOU