From: Management of End-stage Renal Disease Associated with Systemic Rheumatic Diseases
| Diseases | Representative examples |
|---|---|
| SLE | Lupus nephritis |
| Systemic sclerosis | Scleroderma renal crisis |
| AAV | ANCA-associated glomerulonephritis, RPGN |
| anti-GBM disease | anti-GBM glomerulonephritis, RPGN |
| IgA vasculitis | IgA vasculitis nephritis |
| Amyloidosis | Amyloid nephropathy |
| Drug-induced | Calcineurin inhibitor nephrotoxicity |
From: Management of End-stage Renal Disease Associated with Systemic Rheumatic Diseases
| Agent | Recommended dosage |
|---|---|
| Hydroxychloroquine | Both dosage and screening frequency need to be adjusted |
| Mycophenolate mofetil | TDM is recommended. The target MPA-AUC (0-12 h) concentration in rheumatic disease is controversial |
| Cyclophosphamide | Dose adjustment may be required for patients with high serum Cr and/or old age. Intravenous CYC infusions 15 mg/kg/pulse in patients <60 years with low Cr (150–300 μmol/L or 1.7–3.4 mg/dL). 12.5 mg/kg/pulse in patients with 60–70 years and low Cr. 10.0 mg/kg/pulse in patients >70 years with low Cr. 12.5 mg/kg/pulse in patients <60 years with high Cr (300–500 μmol/L or 1.7–3.4 mg/dL). 10.0 mg/kg/pulse in patients with 60–70 years and high Cr. 7.5 mg/kg/pulse in patients >70 years with low Cr. |
| Cyclosporine | TDM is recommended. Trough concentration should not exceed 200 ng/mL. |
| Tacrolimus | TDM is recommended. Trough concentration should not exceed 20 ng/mL. |
| Azathioprine | CCr > 50 mL/minute, no dose adjustment recommended; CCr 10–50 mL/minute, 75% of normal dose; CCr < 10 mL/minute, 50% of normal dose Patients on hemodialysis (–45% removed in 8 hours by dialysis): 50% of normal dose for children; for adults, 50% of normal dose and supplement of 0.25 mg/kg after hemodialysis on dialysis days |
| Methotrexate | Contraindicated |
| Leflunomide | Dose adjustment is not required |
| Sulfasalazine | Dose adjustment is not required |
| Iguratimod | Careful administration is required |
| Bucillamine | Contraindicated |
| Rituximab | Dose adjustment is not required |
| Belimumab | Dose adjustment is not required |
