Egyptian Rheumatology and Rehabilitation (Aug 2022)

Egyptian recommendations for treating to target of lupus nephritis: an evidence-based consensus on clinical practice recommendations for the management of lupus nephritis and pregnancy

  • Yasser El Miedany,
  • Nadia Salah Kamel,
  • Mohammed Hassan Abu-Zaid,
  • Khaled El Hadidi,
  • Geilan Abdelmoneim Mahmoud,
  • Maha El Gaafary,
  • Eman Sarhan,
  • Ahmed Abdel-Nasser,
  • Esam M. Abualfadl,
  • Atef Abdel Azim,
  • Nihal Ahmed Fathi,
  • Abir Mokbel,
  • Waleed Hassan,
  • Mervat Eissa,
  • Samar Abd Alhamed Tabra,
  • Mohamed Mortada,
  • Nermeen Ahmed Fouad,
  • Rehab Elnemr,
  • Ahmed Ezzat Mansour,
  • Ismail Elaraby,
  • Basma M. Medhat,
  • Sally S. Mohamed,
  • Eman Ragab Abdelradi,
  • Rehab Ali Ibrahim,
  • Sally Saber

DOI
https://doi.org/10.1186/s43166-022-00142-0
Journal volume & issue
Vol. 49, no. 1
pp. 1 – 18

Abstract

Read online

Abstract Background Nephritis is known to be one of the most serious complications of lupus and a strong predictor of poor outcome. This study was carried out aiming at setting up an up-to-date recommendation for the management of women living with lupus nephritis and planning for a family throughout conception, pregnancy, and the postpartum period. Ten key clinical questions were identified by the scientific committee according to the Patient/Population, Intervention, Comparison, Outcomes and Timing (PICOT) approach. The literature review team performed a systematic review to summarise evidence advocating the benefits and harms of available pharmacologic and nonpharmacologic therapies for women living with lupus nephritis (LN) and planning for a family. 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 20 recommendation items, categorised into 10 domains to address the main LN with pregnancy categories, were obtained. The percentage of those who agreed with the recommendations (rank 7–9) ranged from 88.5 to 100%. On the phrasing of all the clinical standards defined by the scientific committee, a consensus was reached (i.e., 75% of respondents strongly agreed or agreed). An algorithm for the management of LN with pregnancy has been suggested. Conclusion These recommendations provide an updated consensus on the pharmacological treatment of LN with pregnancy and strategies to reach optimal outcomes for both the mother and newborn in common clinical scenarios, based on a combination of evidence and expert opinion. Best treatment decisions should be tailored to each individual patient’s situation.

Keywords