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Article: Treatment of membranous lupus nephritis with nephrotic syndrome by sequential immunosuppression

TitleTreatment of membranous lupus nephritis with nephrotic syndrome by sequential immunosuppression
Authors
KeywordsAzathioprine
Cyclophosphamide
Membranous lupus nephritis
Nephrotic syndrome
Issue Date1999
PublisherSage Publications Ltd. The Journal's web site is located at http://lup.sagepub.com
Citation
Lupus, 1999, v. 8 n. 7, p. 545-551 How to Cite?
AbstractThe optimal therapy for pure membranous lupus nephritis (MLN) with nephrotic syndrome remains controversial. While the risk of progressive renal deterioration may be small, persistent heavy proteinuria leads to the complications of oedema, hypoalbuminaemia, hyperlipidaemia, hypercoagulability, and venous thrombosis. We examined prospectively the efficacy and tolerability of a sequential immunosuppressive regimen in a cohort of 20 patients with nephrotic syndrome due to pure MLN (WHO Class Va and Vb). Initial therapy comprised prednisolone (0.8 mg/kg/d p.o.) and cyclophosphamide (2-2.5 mg/kg/d p.o.). Prednisolone dosage was gradually tapered to 10 mg/d at 6 months, when cyclophosphamide was replaced by azathioprine (2 mg/kg/d p.o.) as maintenance therapy. Within 12 months of therapy 11 (55%) patients had complete remission (CR), 7 (35%) patients achieved partial remission (PR) (proteinuria reduced from 6.2 ± 4.0 to 2.0 ± 1.7 g/24 h, P < 0.01), and 2 patients failed to respond. Improvements in proteinuria and serum albumin level were observed after 3-6 months of treatment. Non-responders had lower baseline serum albumin compared to complete responders. Renal function remained stable during follow-up for 73.5 ± 48.9 months. 8 patients had disease relapse at 47 ± 15 months. Early complications ( ≤ 12 months) included herpes tester (40%), minor respiratory or urinary tract infections (25%), mild leukopenia (15%), and transient amenorrhea (14.3%). 4 of the 20 patients developed pulmonary tuberculosis during follow-up, at 35 ± 24 months after the diagnosis of MLN. 8 patients had hyperlipidaemia. Haemorrhagic cystitis, permanent amenorrhea, vascular complications, and mortality were not observed. We conclude that this sequential immunosuppressive regimen is effective in 90% of patients with MLN and heavy proteinuria. Prudent consideration of the benefits and potential side-effects is required to determine the optimal management for individual patients.
Persistent Identifierhttp://hdl.handle.net/10722/119501
ISSN
2015 Impact Factor: 2.118
2015 SCImago Journal Rankings: 0.878
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorChan, TMen_HK
dc.contributor.authorLi, FKen_HK
dc.contributor.authorHao, WKen_HK
dc.contributor.authorChan, KWen_HK
dc.contributor.authorLui, SLen_HK
dc.contributor.authorTang, Sen_HK
dc.contributor.authorLai, KNen_HK
dc.date.accessioned2010-09-26T08:54:52Z-
dc.date.available2010-09-26T08:54:52Z-
dc.date.issued1999en_HK
dc.identifier.citationLupus, 1999, v. 8 n. 7, p. 545-551en_HK
dc.identifier.issn0961-2033en_HK
dc.identifier.urihttp://hdl.handle.net/10722/119501-
dc.description.abstractThe optimal therapy for pure membranous lupus nephritis (MLN) with nephrotic syndrome remains controversial. While the risk of progressive renal deterioration may be small, persistent heavy proteinuria leads to the complications of oedema, hypoalbuminaemia, hyperlipidaemia, hypercoagulability, and venous thrombosis. We examined prospectively the efficacy and tolerability of a sequential immunosuppressive regimen in a cohort of 20 patients with nephrotic syndrome due to pure MLN (WHO Class Va and Vb). Initial therapy comprised prednisolone (0.8 mg/kg/d p.o.) and cyclophosphamide (2-2.5 mg/kg/d p.o.). Prednisolone dosage was gradually tapered to 10 mg/d at 6 months, when cyclophosphamide was replaced by azathioprine (2 mg/kg/d p.o.) as maintenance therapy. Within 12 months of therapy 11 (55%) patients had complete remission (CR), 7 (35%) patients achieved partial remission (PR) (proteinuria reduced from 6.2 ± 4.0 to 2.0 ± 1.7 g/24 h, P < 0.01), and 2 patients failed to respond. Improvements in proteinuria and serum albumin level were observed after 3-6 months of treatment. Non-responders had lower baseline serum albumin compared to complete responders. Renal function remained stable during follow-up for 73.5 ± 48.9 months. 8 patients had disease relapse at 47 ± 15 months. Early complications ( ≤ 12 months) included herpes tester (40%), minor respiratory or urinary tract infections (25%), mild leukopenia (15%), and transient amenorrhea (14.3%). 4 of the 20 patients developed pulmonary tuberculosis during follow-up, at 35 ± 24 months after the diagnosis of MLN. 8 patients had hyperlipidaemia. Haemorrhagic cystitis, permanent amenorrhea, vascular complications, and mortality were not observed. We conclude that this sequential immunosuppressive regimen is effective in 90% of patients with MLN and heavy proteinuria. Prudent consideration of the benefits and potential side-effects is required to determine the optimal management for individual patients.en_HK
dc.languageengen_HK
dc.publisherSage Publications Ltd. The Journal's web site is located at http://lup.sagepub.comen_HK
dc.relation.ispartofLupusen_HK
dc.rightsLupus. Copyright © Sage Publications Ltd.en_HK
dc.subjectAzathioprineen_HK
dc.subjectCyclophosphamideen_HK
dc.subjectMembranous lupus nephritisen_HK
dc.subjectNephrotic syndromeen_HK
dc.subject.meshAdulten_HK
dc.subject.meshAlopecia - chemically induceden_HK
dc.subject.meshAnti-Inflammatory Agents - administration & dosage - adverse effectsen_HK
dc.subject.meshAzathioprine - administration & dosage - adverse effectsen_HK
dc.subject.meshCohort Studiesen_HK
dc.subject.meshCyclophosphamide - administration & dosage - adverse effectsen_HK
dc.subject.meshDrug Therapy, Combinationen_HK
dc.subject.meshFemaleen_HK
dc.subject.meshHerpes Zoster - chemically induceden_HK
dc.subject.meshHong Kongen_HK
dc.subject.meshHumansen_HK
dc.subject.meshImmunosuppression - adverse effectsen_HK
dc.subject.meshImmunosuppressive Agents - administration & dosage - adverse effectsen_HK
dc.subject.meshLupus Nephritis - complications - drug therapy - virologyen_HK
dc.subject.meshMaleen_HK
dc.subject.meshMiddle Ageden_HK
dc.subject.meshNephrotic Syndrome - complications - drug therapyen_HK
dc.subject.meshPrednisone - administration & dosage - adverse effectsen_HK
dc.subject.meshProspective Studiesen_HK
dc.subject.meshProteinuria - drug therapy - etiologyen_HK
dc.subject.meshRespiratory Tract Infections - chemically induceden_HK
dc.subject.meshSerum Albuminen_HK
dc.subject.meshTreatment Outcomeen_HK
dc.subject.meshUrinary Tract Infections - chemically induceden_HK
dc.titleTreatment of membranous lupus nephritis with nephrotic syndrome by sequential immunosuppressionen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0961-2033&volume=8&issue=7&spage=545&epage=551&date=1999&atitle=Treatment+of+membranous+lupus+nephritis+with+nephrotic+syndrome+by+sequential+immunosuppressionen_HK
dc.identifier.emailChan, TM: dtmchan@hku.hken_HK
dc.identifier.emailChan, KW: hrmtckw@hku.hken_HK
dc.identifier.emailTang, S: scwtang@hku.hken_HK
dc.identifier.emailLai, KN: knlai@hku.hken_HK
dc.identifier.authorityChan, TM=rp00394en_HK
dc.identifier.authorityChan, KW=rp00330en_HK
dc.identifier.authorityTang, S=rp00480en_HK
dc.identifier.authorityLai, KN=rp00324en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1191/096120399678840837en_HK
dc.identifier.pmid10483033-
dc.identifier.scopuseid_2-s2.0-0032843027en_HK
dc.identifier.hkuros47762en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0032843027&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume8en_HK
dc.identifier.issue7en_HK
dc.identifier.spage545en_HK
dc.identifier.epage551en_HK
dc.identifier.isiWOS:000082933600010-
dc.publisher.placeUnited Kingdomen_HK
dc.identifier.scopusauthoridChan, TM=7402687700en_HK
dc.identifier.scopusauthoridLi, FK=8219093900en_HK
dc.identifier.scopusauthoridHao, WK=37461322500en_HK
dc.identifier.scopusauthoridChan, KW=16444133100en_HK
dc.identifier.scopusauthoridLui, SL=7102379130en_HK
dc.identifier.scopusauthoridTang, S=7403437082en_HK
dc.identifier.scopusauthoridLai, KN=7402135706en_HK

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