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Article: Long-term outcome of diffuse proliferative lupus glomerulonephritis treated with cyclophosphamide
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TitleLong-term outcome of diffuse proliferative lupus glomerulonephritis treated with cyclophosphamide
 
AuthorsMok, CC2 2
Ying, KY1
Ng, WL4
Lee, KW3
To, CH2
Lau, CS5
Wong, RWS5
Au, TC2
 
Issue Date2006
 
PublisherExcerpta Medica, Inc. The Journal's web site is located at http://www.elsevier.com/locate/amj
 
CitationAmerican Journal Of Medicine, 2006, v. 119 n. 4, p. 355.e25-355.e33 [How to Cite?]
DOI: http://dx.doi.org/10.1016/j.amjmed.2005.08.045
 
AbstractPURPOSE: To report the long-term outcome of diffuse proliferative lupus nephritis (DPLN) treated with cyclophosphamide (CYC) in Chinese patients. METHODS: Patients with biopsy-proven DPLN treated with prednisolone and CYC were identified. The long-term renal outcome and treatment-related toxicities were reported. RESULTS: A total of 212 patients were studied (89% women; mean age 30.9 ± 10.9 years; mean system lupus erythematosus [SLE] duration 36.7 ± 55.1 months). At renal biopsy, 148 (70%) patients were nephrotic, and 78 (37%) had impaired serum creatinine. One hundred and three (49%) patients received daily oral CYC, whereas 109 (51%) received intravenous bolus CYC. At last dose of CYC, 126 (59%) patients responded completely, and 56 (26%) responded partially. In a logistic regression model, the cumulative CYC dose and histologic chronicity score predicted complete response. One hundred fifty-five (73%) patients received maintenance immunosuppression for at least 3 years (88% azathioprine). After a follow-up of 1873 patient-years, 66 patients experienced renal flares, 30 had doubling of serum creatinine, 18 developed end-stage renal failure, and 14 died. The renal survival rates were 88.7%, 82.8% and 70.7% at 5, 10 and 15 years, respectively. Failure to respond completely to CYC and the absence of maintenance immunosuppression were independent predictors of a poor renal outcome. Ovarian toxicity was more frequent with the oral CYC regimen. Increasing age and higher cumulative doses of CYC were independent risk factors. CONCLUSIONS: In Chinese patients with DPLN, the cumulative dose, rather than the route of CYC administration, determines the initial treatment response and ovarian toxicity. Maintenance immunosuppression is associated with a better long-term prognosis. The oral CYC regimen is more toxic and should be reserved for high-risk patients. © 2006 Elsevier Inc. All rights reserved.
 
ISSN0002-9343
2012 Impact Factor: 4.768
2012 SCImago Journal Rankings: 1.676
 
DOIhttp://dx.doi.org/10.1016/j.amjmed.2005.08.045
 
ReferencesReferences in Scopus
 
DC FieldValue
dc.contributor.authorMok, CC
 
dc.contributor.authorYing, KY
 
dc.contributor.authorNg, WL
 
dc.contributor.authorLee, KW
 
dc.contributor.authorTo, CH
 
dc.contributor.authorLau, CS
 
dc.contributor.authorWong, RWS
 
dc.contributor.authorAu, TC
 
dc.date.accessioned2012-09-05T05:25:50Z
 
dc.date.available2012-09-05T05:25:50Z
 
dc.date.issued2006
 
dc.description.abstractPURPOSE: To report the long-term outcome of diffuse proliferative lupus nephritis (DPLN) treated with cyclophosphamide (CYC) in Chinese patients. METHODS: Patients with biopsy-proven DPLN treated with prednisolone and CYC were identified. The long-term renal outcome and treatment-related toxicities were reported. RESULTS: A total of 212 patients were studied (89% women; mean age 30.9 ± 10.9 years; mean system lupus erythematosus [SLE] duration 36.7 ± 55.1 months). At renal biopsy, 148 (70%) patients were nephrotic, and 78 (37%) had impaired serum creatinine. One hundred and three (49%) patients received daily oral CYC, whereas 109 (51%) received intravenous bolus CYC. At last dose of CYC, 126 (59%) patients responded completely, and 56 (26%) responded partially. In a logistic regression model, the cumulative CYC dose and histologic chronicity score predicted complete response. One hundred fifty-five (73%) patients received maintenance immunosuppression for at least 3 years (88% azathioprine). After a follow-up of 1873 patient-years, 66 patients experienced renal flares, 30 had doubling of serum creatinine, 18 developed end-stage renal failure, and 14 died. The renal survival rates were 88.7%, 82.8% and 70.7% at 5, 10 and 15 years, respectively. Failure to respond completely to CYC and the absence of maintenance immunosuppression were independent predictors of a poor renal outcome. Ovarian toxicity was more frequent with the oral CYC regimen. Increasing age and higher cumulative doses of CYC were independent risk factors. CONCLUSIONS: In Chinese patients with DPLN, the cumulative dose, rather than the route of CYC administration, determines the initial treatment response and ovarian toxicity. Maintenance immunosuppression is associated with a better long-term prognosis. The oral CYC regimen is more toxic and should be reserved for high-risk patients. © 2006 Elsevier Inc. All rights reserved.
 
dc.description.natureLink_to_subscribed_fulltext
 
dc.identifier.citationAmerican Journal Of Medicine, 2006, v. 119 n. 4, p. 355.e25-355.e33 [How to Cite?]
DOI: http://dx.doi.org/10.1016/j.amjmed.2005.08.045
 
dc.identifier.doihttp://dx.doi.org/10.1016/j.amjmed.2005.08.045
 
dc.identifier.epage355.e33
 
dc.identifier.issn0002-9343
2012 Impact Factor: 4.768
2012 SCImago Journal Rankings: 1.676
 
dc.identifier.issue4
 
dc.identifier.pmid16564783
 
dc.identifier.scopuseid_2-s2.0-33645241849
 
dc.identifier.spage355.e25
 
dc.identifier.urihttp://hdl.handle.net/10722/162954
 
dc.identifier.volume119
 
dc.languageeng
 
dc.publisherExcerpta Medica, Inc. The Journal's web site is located at http://www.elsevier.com/locate/amj
 
dc.publisher.placeUnited States
 
dc.relation.ispartofAmerican Journal of Medicine
 
dc.relation.referencesReferences in Scopus
 
dc.subject.meshAdministration, Oral
 
dc.subject.meshAdult
 
dc.subject.meshAmenorrhea - Chemically Induced
 
dc.subject.meshAnalysis Of Variance
 
dc.subject.meshAnti-Inflammatory Agents - Therapeutic Use
 
dc.subject.meshChina
 
dc.subject.meshCyclophosphamide - Administration & Dosage - Adverse Effects
 
dc.subject.meshDrug Therapy, Combination
 
dc.subject.meshFemale
 
dc.subject.meshHumans
 
dc.subject.meshImmunosuppressive Agents - Administration & Dosage - Adverse Effects
 
dc.subject.meshInjections, Intravenous
 
dc.subject.meshLogistic Models
 
dc.subject.meshLupus Nephritis - Drug Therapy - Pathology
 
dc.subject.meshMale
 
dc.subject.meshOvary - Drug Effects
 
dc.subject.meshPrednisolone - Therapeutic Use
 
dc.subject.meshPrognosis
 
dc.subject.meshRetrospective Studies
 
dc.subject.meshRisk Assessment
 
dc.subject.meshRisk Factors
 
dc.subject.meshTime Factors
 
dc.subject.meshTreatment Failure
 
dc.subject.meshTreatment Outcome
 
dc.titleLong-term outcome of diffuse proliferative lupus glomerulonephritis treated with cyclophosphamide
 
dc.typeArticle
 
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<contributor.author>Lee, KW</contributor.author>
<contributor.author>To, CH</contributor.author>
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Author Affiliations
  1. Princess Margaret Hospital Hong Kong
  2. Tuen Mun Hospital
  3. Pamela Youde Nethersole Eastern Hospital
  4. United Christian Hospital Hong Kong
  5. Queen Mary Hospital Hong Kong