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Lupusová nefritida – novinky v léčbě

Bohumil Pražský
29. 9. 2015 9:53
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Ilustrační obrázek
Autor: VitalikRadko – Depositphotos
Ilustrační obrázek

Souhrn Lupusová nefritida patří mezi nejzávažnější orgánové projevy systémového lupus erythematodes. Léčba proliferativní lupusové nefritidy vyžaduje kombinovanou imunosupresivní terapii, v indukční fázi jsou dnes standardně používány kortikosteroidy spolu s intravenózním cyklofosfamidem, nebo mykofenolátem; v udržovací terapii je poté volen buď mykofenolát, nebo azathioprin. Část pacientů na tuto terapii neodpoví, netoleruje ji nebo se aktivita onemocnění opakovaně vrací, dlouhodobá imunosupresivní terapie je navíc spojena s rizikem potenciálně závažných nežádoucích účinků, a proto je nutné hledat nové terapeutické možnosti. V léčbě je možno použít také kalcineurinové inhibitory. V posledních letech jsou pak stále častěji využívány i novější léčebné alternativy včetně biologické terapie, zejména rituximab, belimumab či abatacept. Klíčová slova SLE • lupusová nefritida • léčba • biologická terapie • rituximab Summary Hruskova, Z., Tesar, V. Lupus nephritis – innovation in treatment Lupus nephritis (LN) is one of the most severe organ manifestations of systemic lupus erythematosus (SLE). Treatment of proliferative LN requires combined immunosuppressive therapy. In the induction phase, the standard treatment consists of corticosteroids plus either intravenous cyclophosphamide or mycophenolate. Azathioprine of mycophenolate are used for the maintenance treatment. Some of the patients do not



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'; document.getElementById('preroll-iframe').onload = function () { setupIframe(); } prerollContainer = document.getElementsByClassName('preroll-container-iframe')[0]; } function setupIframe() { prerollDocument = document.getElementById('preroll-iframe').contentWindow.document; let el = prerollDocument.createElement('style'); prerollDocument.head.appendChild(el); el.innerText = "#adContainer>div:nth-of-type(1),#adContainer>div:nth-of-type(1) > iframe { width: 99% !important;height: 99% !important;max-width: 100%;}#videoContent,body{ width:100vw;height:100vh}body{ font-family:'Helvetica Neue',Arial,sans-serif}#videoContent{ overflow:hidden;background:#000}#adMuteBtn{ width:35px;height:35px;border:0;background:0 0;display:none;position:absolute;fill:rgba(230,230,230,1);bottom:20px;right:25px}"; videoContent = prerollDocument.getElementById('contentElement'); videoContent.style.display = 'none'; videoContent.volume = 1; videoContent.muted = false; const playPromise = videoContent.play(); if (playPromise !== undefined) { playPromise.then(function () { console.log('PREROLL sound allowed'); // setUpIMA(true); videoContent.volume = 1; videoContent.muted = false; setUpIMA(); }).catch(function () { console.log('PREROLL sound forbidden'); videoContent.volume = 0; videoContent.muted = true; setUpIMA(); }); } } function setupDimensions() { prerollWidth = Math.min(iinfoPrerollPosition.offsetWidth, 480); prerollHeight = Math.min(iinfoPrerollPosition.offsetHeight, 320); } function setUpIMA() { google.ima.settings.setDisableCustomPlaybackForIOS10Plus(true); google.ima.settings.setLocale('cs'); google.ima.settings.setNumRedirects(10); // Create the ad display container. createAdDisplayContainer(); // Create ads loader. adsLoader = new google.ima.AdsLoader(adDisplayContainer); // Listen and respond to ads loaded and error events. adsLoader.addEventListener( google.ima.AdsManagerLoadedEvent.Type.ADS_MANAGER_LOADED, onAdsManagerLoaded, false); adsLoader.addEventListener( google.ima.AdErrorEvent.Type.AD_ERROR, onAdError, false); // An event listener to tell the SDK that our content video // is completed so the SDK can play any post-roll ads. const contentEndedListener = function () { adsLoader.contentComplete(); }; videoContent.onended = contentEndedListener; // Request video ads. const adsRequest = new google.ima.AdsRequest(); adsRequest.adTagUrl = iinfoVastUrls[iinfoVastUrlIndex]; console.log('Preroll advert: ' + iinfoVastUrls[iinfoVastUrlIndex]); videoContent.muted = false; videoContent.volume = 1; // Specify the linear and nonlinear slot sizes. This helps the SDK to // select the correct creative if multiple are returned. // adsRequest.linearAdSlotWidth = prerollWidth; // adsRequest.linearAdSlotHeight = prerollHeight; adsRequest.nonLinearAdSlotWidth = 0; adsRequest.nonLinearAdSlotHeight = 0; adsLoader.requestAds(adsRequest); } function createAdDisplayContainer() { // We assume the adContainer is the DOM id of the element that will house // the ads. prerollDocument.getElementById('videoContent').style.display = 'none'; adDisplayContainer = new google.ima.AdDisplayContainer( prerollDocument.getElementById('adContainer'), videoContent); } function unmutePrerollAdvert() { adVolume = !adVolume; if (adVolume) { adsManager.setVolume(0.3); prerollDocument.getElementById('adMuteBtn').innerHTML = ''; } else { adsManager.setVolume(0); prerollDocument.getElementById('adMuteBtn').innerHTML = ''; } } function onAdsManagerLoaded(adsManagerLoadedEvent) { // Get the ads manager. const adsRenderingSettings = new google.ima.AdsRenderingSettings(); adsRenderingSettings.restoreCustomPlaybackStateOnAdBreakComplete = true; adsRenderingSettings.loadVideoTimeout = 12000; // videoContent should be set to the content video element. adsManager = adsManagerLoadedEvent.getAdsManager(videoContent, adsRenderingSettings); // Add listeners to the required events. adsManager.addEventListener(google.ima.AdErrorEvent.Type.AD_ERROR, onAdError); adsManager.addEventListener( google.ima.AdEvent.Type.CONTENT_PAUSE_REQUESTED, onContentPauseRequested); adsManager.addEventListener( google.ima.AdEvent.Type.CONTENT_RESUME_REQUESTED, onContentResumeRequested); adsManager.addEventListener( google.ima.AdEvent.Type.ALL_ADS_COMPLETED, onAdEvent); // Listen to any additional events, if necessary. adsManager.addEventListener(google.ima.AdEvent.Type.LOADED, onAdEvent); adsManager.addEventListener(google.ima.AdEvent.Type.STARTED, onAdEvent); adsManager.addEventListener(google.ima.AdEvent.Type.COMPLETE, onAdEvent); playAds(); } function playAds() { // Initialize the container. Must be done through a user action on mobile // devices. videoContent.load(); adDisplayContainer.initialize(); // setupDimensions(); try { // Initialize the ads manager. Ad rules playlist will start at this time. adsManager.init(1920, 1080, google.ima.ViewMode.NORMAL); // Call play to start showing the ad. Single video and overlay ads will // start at this time; the call will be ignored for ad rules. adsManager.start(); // window.addEventListener('resize', function (event) { // if (adsManager) { // setupDimensions(); // adsManager.resize(prerollWidth, prerollHeight, google.ima.ViewMode.NORMAL); // } // }); } catch (adError) { // An error may be thrown if there was a problem with the VAST response. // videoContent.play(); } } function onAdEvent(adEvent) { const ad = adEvent.getAd(); console.log('Preroll event: ' + adEvent.type); switch (adEvent.type) { case google.ima.AdEvent.Type.LOADED: if (!ad.isLinear()) { videoContent.play(); } prerollDocument.getElementById('adContainer').style.width = '100%'; prerollDocument.getElementById('adContainer').style.maxWidth = '640px'; prerollDocument.getElementById('adContainer').style.height = '360px'; break; case google.ima.AdEvent.Type.STARTED: window.addEventListener('scroll', onActiveView); if (ad.isLinear()) { intervalTimer = setInterval( function () { // Example: const remainingTime = adsManager.getRemainingTime(); // adsManager.pause(); }, 300); // every 300ms } prerollDocument.getElementById('adMuteBtn').style.display = 'block'; break; case google.ima.AdEvent.Type.ALL_ADS_COMPLETED: if (ad.isLinear()) { clearInterval(intervalTimer); } if (prerollLastError === 303) { playYtVideo(); } break; case google.ima.AdEvent.Type.COMPLETE: if (ad.isLinear()) { clearInterval(intervalTimer); } playYtVideo(); break; } } function onAdError(adErrorEvent) { console.log(adErrorEvent.getError()); prerollLastError = adErrorEvent.getError().getErrorCode(); if (!loadNext()) { playYtVideo(); } } function loadNext() { iinfoVastUrlIndex++; if (iinfoVastUrlIndex < iinfoVastUrls.length) { iinfoPrerollPosition.remove(); playPrerollAd(); } else { return false; } adVolume = 1; return true; } function onContentPauseRequested() { videoContent.pause(); } function onContentResumeRequested() { videoContent.play(); } function onActiveView() { if (prerollContainer) { const containerOffset = prerollContainer.getBoundingClientRect(); const windowHeight = window.innerHeight; if (containerOffset.top < windowHeight/1 && containerOffset.bottom > 0.0) { if (prerollPaused) { adsManager.resume(); prerollPaused = false; } return true; } else { if (!prerollPaused) { adsManager.pause(); prerollPaused = true; } } } return false; } function playYtVideo() { iinfoPrerollPosition.remove(); youtubeIframe.style.display = 'block'; youtubeIframe.src += '&autoplay=1&mute=1'; } }
'; document.getElementById('outstream-iframe').onload = function () { setupIframe(); } replayScreen = document.getElementById('iinfoOutstreamReplay'); iinfoOutstreamPosition = document.getElementById('iinfoOutstreamPosition'); outstreamContainer = document.getElementsByClassName('outstream-container')[0]; setupReplayScreen(); } function setupIframe() { outstreamDocument = document.getElementById('outstream-iframe').contentWindow.document; let el = outstreamDocument.createElement('style'); outstreamDocument.head.appendChild(el); el.innerText = "#adContainer>div:nth-of-type(1),#adContainer>div:nth-of-type(1) > iframe { width: 99% !important;height: 99% !important;max-width: 100%;}#videoContent,body{ width:100vw;height:100vh}body{ font-family:'Helvetica Neue',Arial,sans-serif}#videoContent{ overflow:hidden;background:#000}#adMuteBtn{ width:35px;height:35px;border:0;background:0 0;display:none;position:absolute;fill:rgba(230,230,230,1);bottom:-5px;right:25px}"; videoContent = outstreamDocument.getElementById('contentElement'); videoContent.style.display = 'none'; videoContent.volume = 1; videoContent.muted = false; if ( location.href.indexOf('rejstriky.finance.cz') !== -1 || location.href.indexOf('finance-rejstrik') !== -1 || location.href.indexOf('firmy.euro.cz') !== -1 || location.href.indexOf('euro-rejstrik') !== -1 || location.href.indexOf('/rejstrik/') !== -1 || location.href.indexOf('/rejstrik-firem/') !== -1) { outstreamDirectPlayed = true; soundAllowed = true; iinfoVastUrlIndex = 0; } if (!outstreamDirectPlayed) { console.log('OUTSTREAM direct'); setUpIMA(true); } else { if (soundAllowed) { const playPromise = videoContent.play(); if (playPromise !== undefined) { playPromise.then(function () { console.log('OUTSTREAM sound allowed'); setUpIMA(false); }).catch(function () { console.log('OUTSTREAM sound forbidden'); renderBanner(); }); } } else { renderBanner(); } } } function getWrapper() { let articleWrapper = document.querySelector('.rs-outstream-placeholder'); // Outstream Placeholder from RedSys manipulation if (articleWrapper && articleWrapper.style.display !== 'block') { articleWrapper.innerHTML = ""; articleWrapper.style.display = 'block'; } // Don't render OutStream on homepages if (articleWrapper === null) { if (document.querySelector('body.p-index')) { return null; } } if (articleWrapper === null) { articleWrapper = document.getElementById('iinfo-outstream'); } if (articleWrapper === null) { articleWrapper = document.querySelector('.layout-main__content .detail__article p:nth-of-type(6)'); } if (articleWrapper === null) { // Euro, Autobible, Zdravi articleWrapper = document.querySelector('.o-article .o-article__text p:nth-of-type(6)'); } if (articleWrapper === null) { articleWrapper = document.getElementById('sidebar'); } if (!articleWrapper) { console.error("Outstream wrapper of article was not found."); } return articleWrapper; } function setupDimensions() { outstreamWidth = Math.min(iinfoOutstreamPosition.offsetWidth, 480); outstreamHeight = Math.min(iinfoOutstreamPosition.offsetHeight, 320); } /** * Sets up IMA ad display container, ads loader, and makes an ad request. */ function setUpIMA(direct) { google.ima.settings.setDisableCustomPlaybackForIOS10Plus(true); google.ima.settings.setLocale('cs'); google.ima.settings.setNumRedirects(10); // Create the ad display container. createAdDisplayContainer(); // Create ads loader. adsLoader = new google.ima.AdsLoader(adDisplayContainer); // Listen and respond to ads loaded and error events. adsLoader.addEventListener( google.ima.AdsManagerLoadedEvent.Type.ADS_MANAGER_LOADED, onAdsManagerLoaded, false); adsLoader.addEventListener( google.ima.AdErrorEvent.Type.AD_ERROR, onAdError, false); // An event listener to tell the SDK that our content video // is completed so the SDK can play any post-roll ads. const contentEndedListener = function () { adsLoader.contentComplete(); }; videoContent.onended = contentEndedListener; // Request video ads. const adsRequest = new google.ima.AdsRequest(); if (direct) { adsRequest.adTagUrl = directVast; console.log('Outstream DIRECT CAMPAING advert: ' + directVast); videoContent.muted = true; videoContent.volume = 0; outstreamDirectPlayed = true; } else { adsRequest.adTagUrl = iinfoVastUrls[iinfoVastUrlIndex]; console.log('Outstream advert: ' + iinfoVastUrls[iinfoVastUrlIndex]); videoContent.muted = false; videoContent.volume = 1; } // Specify the linear and nonlinear slot sizes. This helps the SDK to // select the correct creative if multiple are returned. // adsRequest.linearAdSlotWidth = outstreamWidth; // adsRequest.linearAdSlotHeight = outstreamHeight; adsRequest.nonLinearAdSlotWidth = 0; adsRequest.nonLinearAdSlotHeight = 0; adsLoader.requestAds(adsRequest); } function setupReplayScreen() { replayScreen.addEventListener('click', function () { iinfoOutstreamPosition.remove(); iinfoVastUrlIndex = 0; outstreamInit(); }); } /** * Sets the 'adContainer' div as the IMA ad display container. */ function createAdDisplayContainer() { // We assume the adContainer is the DOM id of the element that will house // the ads. outstreamDocument.getElementById('videoContent').style.display = 'none'; adDisplayContainer = new google.ima.AdDisplayContainer( outstreamDocument.getElementById('adContainer'), videoContent); } function unmuteAdvert() { adVolume = !adVolume; if (adVolume) { adsManager.setVolume(0.3); outstreamDocument.getElementById('adMuteBtn').innerHTML = ''; } else { adsManager.setVolume(0); outstreamDocument.getElementById('adMuteBtn').innerHTML = ''; } } /** * Loads the video content and initializes IMA ad playback. */ function playAds() { // Initialize the container. Must be done through a user action on mobile // devices. videoContent.load(); adDisplayContainer.initialize(); // setupDimensions(); try { // Initialize the ads manager. Ad rules playlist will start at this time. adsManager.init(1920, 1080, google.ima.ViewMode.NORMAL); // Call play to start showing the ad. Single video and overlay ads will // start at this time; the call will be ignored for ad rules. adsManager.start(); // window.addEventListener('resize', function (event) { // if (adsManager) { // setupDimensions(); // adsManager.resize(outstreamWidth, outstreamHeight, google.ima.ViewMode.NORMAL); // } // }); } catch (adError) { // An error may be thrown if there was a problem with the VAST response. // videoContent.play(); } } /** * Handles the ad manager loading and sets ad event listeners. * @param { !google.ima.AdsManagerLoadedEvent } adsManagerLoadedEvent */ function onAdsManagerLoaded(adsManagerLoadedEvent) { // Get the ads manager. const adsRenderingSettings = new google.ima.AdsRenderingSettings(); adsRenderingSettings.restoreCustomPlaybackStateOnAdBreakComplete = true; adsRenderingSettings.loadVideoTimeout = 12000; // videoContent should be set to the content video element. adsManager = adsManagerLoadedEvent.getAdsManager(videoContent, adsRenderingSettings); // Add listeners to the required events. adsManager.addEventListener(google.ima.AdErrorEvent.Type.AD_ERROR, onAdError); adsManager.addEventListener( google.ima.AdEvent.Type.CONTENT_PAUSE_REQUESTED, onContentPauseRequested); adsManager.addEventListener( google.ima.AdEvent.Type.CONTENT_RESUME_REQUESTED, onContentResumeRequested); adsManager.addEventListener( google.ima.AdEvent.Type.ALL_ADS_COMPLETED, onAdEvent); // Listen to any additional events, if necessary. adsManager.addEventListener(google.ima.AdEvent.Type.LOADED, onAdEvent); adsManager.addEventListener(google.ima.AdEvent.Type.STARTED, onAdEvent); adsManager.addEventListener(google.ima.AdEvent.Type.COMPLETE, onAdEvent); playAds(); } /** * Handles actions taken in response to ad events. * @param { !google.ima.AdEvent } adEvent */ function onAdEvent(adEvent) { // Retrieve the ad from the event. Some events (for example, // ALL_ADS_COMPLETED) don't have ad object associated. const ad = adEvent.getAd(); console.log('Outstream event: ' + adEvent.type); switch (adEvent.type) { case google.ima.AdEvent.Type.LOADED: // This is the first event sent for an ad - it is possible to // determine whether the ad is a video ad or an overlay. if (!ad.isLinear()) { // Position AdDisplayContainer correctly for overlay. // Use ad.width and ad.height. videoContent.play(); } outstreamDocument.getElementById('adContainer').style.width = '100%'; outstreamDocument.getElementById('adContainer').style.maxWidth = '640px'; outstreamDocument.getElementById('adContainer').style.height = '360px'; break; case google.ima.AdEvent.Type.STARTED: window.addEventListener('scroll', onActiveView); // This event indicates the ad has started - the video player // can adjust the UI, for example display a pause button and // remaining time. if (ad.isLinear()) { // For a linear ad, a timer can be started to poll for // the remaining time. intervalTimer = setInterval( function () { // Example: const remainingTime = adsManager.getRemainingTime(); // adsManager.pause(); }, 300); // every 300ms } outstreamDocument.getElementById('adMuteBtn').style.display = 'block'; break; case google.ima.AdEvent.Type.ALL_ADS_COMPLETED: if (ad.isLinear()) { clearInterval(intervalTimer); } if (outstreamLastError === 303) { if (isBanner) { renderBanner(); } else { replayScreen.style.display = 'flex'; } } break; case google.ima.AdEvent.Type.COMPLETE: // This event indicates the ad has finished - the video player // can perform appropriate UI actions, such as removing the timer for // remaining time detection. if (ad.isLinear()) { clearInterval(intervalTimer); } if (isBanner) { renderBanner(); } else { replayScreen.style.display = 'flex'; } break; } } /** * Handles ad errors. * @param { !google.ima.AdErrorEvent } adErrorEvent */ function onAdError(adErrorEvent) { // Handle the error logging. console.log(adErrorEvent.getError()); outstreamLastError = adErrorEvent.getError().getErrorCode(); if (!loadNext()) { renderBanner(); } } function renderBanner() { if (isBanner) { console.log('Outstream: Render Banner'); iinfoOutstreamPosition.innerHTML = ""; iinfoOutstreamPosition.style.height = "330px"; iinfoOutstreamPosition.appendChild(bannerDiv); } else { console.log('Outstream: Banner is not set'); } } function loadNext() { iinfoVastUrlIndex++; if (iinfoVastUrlIndex < iinfoVastUrls.length) { iinfoOutstreamPosition.remove(); outstreamInit(); } else { return false; } adVolume = 1; return true; } /** * Pauses video content and sets up ad UI. */ function onContentPauseRequested() { videoContent.pause(); // This function is where you should setup UI for showing ads (for example, // display ad timer countdown, disable seeking and more.) // setupUIForAds(); } /** * Resumes video content and removes ad UI. */ function onContentResumeRequested() { videoContent.play(); // This function is where you should ensure that your UI is ready // to play content. It is the responsibility of the Publisher to // implement this function when necessary. // setupUIForContent(); } function onActiveView() { if (outstreamContainer) { const containerOffset = outstreamContainer.getBoundingClientRect(); const windowHeight = window.innerHeight; if (containerOffset.top < windowHeight/1 && containerOffset.bottom > 0.0) { if (outstreamPaused) { adsManager.resume(); outstreamPaused = false; } return true; } else { if (!outstreamPaused) { adsManager.pause(); outstreamPaused = true; } } } return false; } let outstreamInitInterval; if (typeof cpexPackage !== "undefined") { outstreamInitInterval = setInterval(tryToInitializeOutstream, 100); } else { const wrapper = getWrapper(); if (wrapper) { let outstreamInitialized = false; window.addEventListener('scroll', () => { if (!outstreamInitialized) { const containerOffset = wrapper.getBoundingClientRect(); const windowHeight = window.innerHeight; if (containerOffset.top < windowHeight / 1 && containerOffset.bottom > 0.0) { outstreamInit(); outstreamInitialized = true; } } }); } } function tryToInitializeOutstream() { const wrapper = getWrapper(); if (wrapper) { const containerOffset = wrapper.getBoundingClientRect(); const windowHeight = window.innerHeight; if (containerOffset.top < windowHeight / 1 && containerOffset.bottom > 0.0) { if (cpexPackage.adserver.displayed) { clearInterval(outstreamInitInterval); outstreamInit(); } } } else { clearInterval(outstreamInitInterval); } } }
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