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Article: Treatment of Pure Membranous Lupus Nephropathy with Prednisone and Azathioprine: An Open-Label Trial

TitleTreatment of Pure Membranous Lupus Nephropathy with Prednisone and Azathioprine: An Open-Label Trial
Authors
Issue Date2004
PublisherWB Saunders Co. The Journal's web site is located at http://www.elsevier.com/locate/ajkd
Citation
American Journal Of Kidney Diseases, 2004, v. 43 n. 2, p. 269-276 How to Cite?
AbstractBackground: The aim of this study was to report the outcome of pure membranous lupus nephropathy treated with prednisone and azathioprine (AZA). Methods: Consecutive patients with pure membranous lupus glomerulonephritis (World Health Organization [WHO] Va and Vb) from 4 regional hospitals were recruited for an open-label treatment trial consisting of prednisone and AZA. Remission status was evaluated at 12 months. Maintenance treatment with low-dose prednisone and AZA was continued indefinitely for those who achieved remission. Factors predictive of initial renal remission and subsequent relapse were studied by statistical analyses. Results: Thirty-eight patients (31 women and 7 men) were studied. The mean age was 35.0 ± 9.2 years, and the duration of systemic lupus erythematosus was 48.5 ± 59 months. Seventeen (45%) patients had WHO class Va lupus nephritis, whereas 21 (55%) had class Vb disease. Two patients withdrew from the protocol because of idiosyncratic reactions to AZA. At 12 months, 24 (67%) patients achieved complete remission (CR), 8 (22%) achieved partial remission (PR), and 4 (11 %) were treatment resistant. Patients who achieved CR or PR were maintained on low-dose prednisone and AZA. Over a mean follow-up period of 90.4 ± 59 months, 6 (19%) patients had relapse of nephritis (proteinuric flare in 4 and nephritic flare in 2). The cumulative risk of renal relapse was 12% at 36 months and 16% at 60 months. No particular clinical variables were found to predict renal remission or relapses. Over a mean follow-up of 90 months, 13% of patients had decline of creatinine clearance by 20%, but none had doubling of serum creatinine. Renal outcome was not significantly worse in patients presenting with nephrotic syndrome. Treatment generally was well tolerated. Conclusion: A combination of prednisone and AZA is reasonably effective for the initial treatment of pure membranous lupus nephritis. Severe adverse effects are uncommon. The additional efficacy of AZA in comparison with prednisone alone has to be confirmed with randomized, controlled trials. © 2004 by the National Kidney Foundation, Inc.
Persistent Identifierhttp://hdl.handle.net/10722/162753
ISSN
2015 Impact Factor: 6.269
2015 SCImago Journal Rankings: 2.313
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorMok, CCen_US
dc.contributor.authorYing, KYen_US
dc.contributor.authorLau, CSen_US
dc.contributor.authorYim, CWen_US
dc.contributor.authorNg, WLen_US
dc.contributor.authorWong, WSen_US
dc.contributor.authorAu, TCen_US
dc.date.accessioned2012-09-05T05:23:06Z-
dc.date.available2012-09-05T05:23:06Z-
dc.date.issued2004en_US
dc.identifier.citationAmerican Journal Of Kidney Diseases, 2004, v. 43 n. 2, p. 269-276en_US
dc.identifier.issn0272-6386en_US
dc.identifier.urihttp://hdl.handle.net/10722/162753-
dc.description.abstractBackground: The aim of this study was to report the outcome of pure membranous lupus nephropathy treated with prednisone and azathioprine (AZA). Methods: Consecutive patients with pure membranous lupus glomerulonephritis (World Health Organization [WHO] Va and Vb) from 4 regional hospitals were recruited for an open-label treatment trial consisting of prednisone and AZA. Remission status was evaluated at 12 months. Maintenance treatment with low-dose prednisone and AZA was continued indefinitely for those who achieved remission. Factors predictive of initial renal remission and subsequent relapse were studied by statistical analyses. Results: Thirty-eight patients (31 women and 7 men) were studied. The mean age was 35.0 ± 9.2 years, and the duration of systemic lupus erythematosus was 48.5 ± 59 months. Seventeen (45%) patients had WHO class Va lupus nephritis, whereas 21 (55%) had class Vb disease. Two patients withdrew from the protocol because of idiosyncratic reactions to AZA. At 12 months, 24 (67%) patients achieved complete remission (CR), 8 (22%) achieved partial remission (PR), and 4 (11 %) were treatment resistant. Patients who achieved CR or PR were maintained on low-dose prednisone and AZA. Over a mean follow-up period of 90.4 ± 59 months, 6 (19%) patients had relapse of nephritis (proteinuric flare in 4 and nephritic flare in 2). The cumulative risk of renal relapse was 12% at 36 months and 16% at 60 months. No particular clinical variables were found to predict renal remission or relapses. Over a mean follow-up of 90 months, 13% of patients had decline of creatinine clearance by 20%, but none had doubling of serum creatinine. Renal outcome was not significantly worse in patients presenting with nephrotic syndrome. Treatment generally was well tolerated. Conclusion: A combination of prednisone and AZA is reasonably effective for the initial treatment of pure membranous lupus nephritis. Severe adverse effects are uncommon. The additional efficacy of AZA in comparison with prednisone alone has to be confirmed with randomized, controlled trials. © 2004 by the National Kidney Foundation, Inc.en_US
dc.languageengen_US
dc.publisherWB Saunders Co. The Journal's web site is located at http://www.elsevier.com/locate/ajkden_US
dc.relation.ispartofAmerican Journal of Kidney Diseasesen_US
dc.subject.meshAdulten_US
dc.subject.meshAnti-Inflammatory Agents - Therapeutic Useen_US
dc.subject.meshAsian Continental Ancestry Groupen_US
dc.subject.meshAzathioprine - Therapeutic Useen_US
dc.subject.meshFemaleen_US
dc.subject.meshHumansen_US
dc.subject.meshImmunosuppressive Agents - Therapeutic Useen_US
dc.subject.meshLupus Nephritis - Drug Therapy - Ethnologyen_US
dc.subject.meshMaleen_US
dc.subject.meshPrednisone - Therapeutic Useen_US
dc.subject.meshRemission Inductionen_US
dc.subject.meshTreatment Outcomeen_US
dc.titleTreatment of Pure Membranous Lupus Nephropathy with Prednisone and Azathioprine: An Open-Label Trialen_US
dc.typeArticleen_US
dc.identifier.emailLau, CS:cslau@hku.hken_US
dc.identifier.authorityLau, CS=rp01348en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1053/j.ajkd.2003.10.029en_US
dc.identifier.pmid14750092-
dc.identifier.scopuseid_2-s2.0-0742305474en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0742305474&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume43en_US
dc.identifier.issue2en_US
dc.identifier.spage269en_US
dc.identifier.epage276en_US
dc.identifier.isiWOS:000188921000008-
dc.publisher.placeUnited Statesen_US
dc.identifier.scopusauthoridMok, CC=7102344226en_US
dc.identifier.scopusauthoridYing, KY=7005162138en_US
dc.identifier.scopusauthoridLau, CS=14035682100en_US
dc.identifier.scopusauthoridYim, CW=7006077693en_US
dc.identifier.scopusauthoridNg, WL=7401613401en_US
dc.identifier.scopusauthoridWong, WS=8737892100en_US
dc.identifier.scopusauthoridAu, TC=7006646148en_US

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