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Article: Treatment of small vessel vasculitis affecting the kidneys

TitleTreatment of small vessel vasculitis affecting the kidneys
Authors
KeywordsAnti-Neutrophil Cytoplasm Antibody
Crescentic Glomerulonephritis
Polyarteritis
Vasculitis
Wegener's Granulomatosis
Issue Date1996
PublisherBlackwell Publishing Asia. The Journal's web site is located at http://www.blackwellpublishing.com/journals/NEP
Citation
Nephrology, 1996, v. 2 SUPPL. 1, p. S31-S34 How to Cite?
AbstractTreatment of vasculitis can be divided into two phases: (i) an induction phase to achieve remission, abate destructive inflammation and minimize scarring; and (ii) the maintenance phase to sustain patients in remission with minimal treatment-related side-effects. A combination of corticosteroids and cytotoxic agents is commonly used as induction therapy. The dose and route of administration of corticosteroids have not been studied adequately, but intravenous (i.v.) bolus doses of methylprednisolone are often administered to patients with severe disease. It has the advantage of fewer side-effects compared to prolonged high dose oral corticosteroids, and the immediate immuno-modulatory effects of the steroid boluses may confer additional therapeutic benefits. It is the general impression that cyclophosphamide is more effective than azathioprine in the acute phase of patients with severe disease. The use of cyclophosphamide by i.v. pulse rather than orally is contentious, and some recent studies have demonstrated its failure to induce sustained remission. Azathioprine with low dose corticosteroids is often employed as long-term maintenance immunosuppression, although low dose cyclophosphamide has also been used for such purpose, which should be withdrawn after 1 year of remission because of its potential side-effects. Clinical and serologic parameters are useful monitors during maintenance therapy. Although serial levels of anti-neutrophil cytoplasm antibodies (ANCA) correlate with disease activity, some patients remain well despite positive or increasing levels of ANCA. Consequently, whether immunosuppressive therapy should be escalated based on increasing ANCA levels alone remains controversial.
Persistent Identifierhttp://hdl.handle.net/10722/162831
ISSN
2015 Impact Factor: 1.796
2015 SCImago Journal Rankings: 0.894
References

 

DC FieldValueLanguage
dc.contributor.authorChan, TMen_US
dc.contributor.authorCameron, JSen_US
dc.date.accessioned2012-09-05T05:24:03Z-
dc.date.available2012-09-05T05:24:03Z-
dc.date.issued1996en_US
dc.identifier.citationNephrology, 1996, v. 2 SUPPL. 1, p. S31-S34en_US
dc.identifier.issn1320-5358en_US
dc.identifier.urihttp://hdl.handle.net/10722/162831-
dc.description.abstractTreatment of vasculitis can be divided into two phases: (i) an induction phase to achieve remission, abate destructive inflammation and minimize scarring; and (ii) the maintenance phase to sustain patients in remission with minimal treatment-related side-effects. A combination of corticosteroids and cytotoxic agents is commonly used as induction therapy. The dose and route of administration of corticosteroids have not been studied adequately, but intravenous (i.v.) bolus doses of methylprednisolone are often administered to patients with severe disease. It has the advantage of fewer side-effects compared to prolonged high dose oral corticosteroids, and the immediate immuno-modulatory effects of the steroid boluses may confer additional therapeutic benefits. It is the general impression that cyclophosphamide is more effective than azathioprine in the acute phase of patients with severe disease. The use of cyclophosphamide by i.v. pulse rather than orally is contentious, and some recent studies have demonstrated its failure to induce sustained remission. Azathioprine with low dose corticosteroids is often employed as long-term maintenance immunosuppression, although low dose cyclophosphamide has also been used for such purpose, which should be withdrawn after 1 year of remission because of its potential side-effects. Clinical and serologic parameters are useful monitors during maintenance therapy. Although serial levels of anti-neutrophil cytoplasm antibodies (ANCA) correlate with disease activity, some patients remain well despite positive or increasing levels of ANCA. Consequently, whether immunosuppressive therapy should be escalated based on increasing ANCA levels alone remains controversial.en_US
dc.languageengen_US
dc.publisherBlackwell Publishing Asia. The Journal's web site is located at http://www.blackwellpublishing.com/journals/NEPen_US
dc.relation.ispartofNephrologyen_US
dc.subjectAnti-Neutrophil Cytoplasm Antibodyen_US
dc.subjectCrescentic Glomerulonephritisen_US
dc.subjectPolyarteritisen_US
dc.subjectVasculitisen_US
dc.subjectWegener's Granulomatosisen_US
dc.titleTreatment of small vessel vasculitis affecting the kidneysen_US
dc.typeArticleen_US
dc.identifier.emailChan, TM:dtmchan@hku.hken_US
dc.identifier.authorityChan, TM=rp00394en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.scopuseid_2-s2.0-1842522998en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-1842522998&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume2en_US
dc.identifier.issueSUPPL. 1en_US
dc.identifier.spageS31en_US
dc.identifier.epageS34en_US
dc.publisher.placeAustraliaen_US
dc.identifier.scopusauthoridChan, TM=7402687700en_US
dc.identifier.scopusauthoridCameron, JS=7403711319en_US

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