Immunosuppressive Treatment for Lupus Nephritis: Long-Term Results in 178 Patients
نویسندگان
چکیده
Lupus nephritis is one of the most severe Systemic Lupus Erythematosus features, defining treatment modality and prognosis. Our retrospective study, including 178 patients treated for lupus nephritis during 23 years with mostly cyclophosphamide-based initial regimens followed by azathioprine or mycophenolic acid, demonstrates 84.8% of renal response with 19.2% of flares, 15-year patient survival 78.7% and kidney survival 76.3%, and low damage accrual. Both patient and kidney survival significantly differ for subgroups that achieved complete or partial renal response and nonresponders: patient 15-year survival 95% versus 65% versus 35%; kidney 15-year survival 100% versus 58% versus 0%, respectively. 51% (24 out of 47) of patients evaluated at the end of the study period sustained complete renal response; however, only 9 of them had 0 disease activity according to SELENA SLEDAI scale, while 13 patients had scores 2-4 due to the serological abnormalities only. We conclude that (1) initial treatment with cyclophosphamide followed by azathioprine is effective and can be used in agreement with International Guidelines until the evidence for biological treatments benefits becomes available; (2) complete and even partial renal response have positive prognostic value, and failure to achieve renal response negatively influences kidney and patient survival; (3) the validity of complete renal response in SLE is questioned by the absence of conventional definition of SLE remission.
منابع مشابه
COMBINATION THERAPY WITH PULSE CYCLOPHOSPHAMIDE PLUS CORTICOSTEROIDS IMPROVES RENAL OUTCOME IN PATIENTS WITH LUPUS NEPHRITIS
ABSTRACT Background: The prognosis of SLE is int1uenced by the onset of glomerulonephtitis. Clinical ttials in lupus nephritis have demonstrated that cyclophosphamide therapy is the superior regimen in the management oflupus nephritis for preserving renal function. Objective: The purpose of this study is to define the outcome of renal function with bolus pu lses of cyclophosphamide and steroid...
متن کاملEpidemiologic study of 40 patients with lupus nephritis in Imam Khomeini
Introduction: Systemic lupus erythematosus (SLE) is an inflammatory systemic disease that involves different organs such as heart, lungs, hematologic and musculoskletal systems, gastrointestinal tract and kidneys. Renal involvement has specific importance in disease prognosis. The present study was conducted to identify epidemiologic status, short term effects of treatment on renal involvemen...
متن کاملنتایج درمان نفریت لوپوسی پرولیفراتیو مقاوم به درمان با سیکلوسپورین A
Background & Aims: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by various autoantibodies formation and immune complex deposition in various organs. Lupus nephritis is a common and severe manifestation of SLE that can lead to end stage renal disease and death. The aim of this study was to evaluate the long-term efficacy of cyclosporine A in the treat...
متن کاملRole of early repeated renal biopsies in lupus nephritis
OBJECTIVES A renal biopsy is generally recommended for diagnosis and is necessary for classification of lupus nephritis (LN), but second biopsies after immunosuppressive therapy are seldom a routine procedure. We investigated how repeat biopsies contribute to the evaluation of treatment response and long-term outcome in LN. METHODS Sixty-seven patients with active LN were included. Renal biop...
متن کاملHuman clinical trials in lupus nephritis.
Improved patient survival after treatment of lupus nephritis with corticosteroids, immunosuppressants, and renal replacement therapy allows greater emphasis on long-term management issues. In particular, the recent focus has been on therapies to treat nephritis with fewer adverse effects compared with cyclophosphamide and immunosuppressive regimens. Issues complicating clinical trial design in ...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
دوره 2016 شماره
صفحات -
تاریخ انتشار 2016