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Article: Long-term outcome of diffuse proliferative lupus glomerulonephritis treated with cyclophosphamide

TitleLong-term outcome of diffuse proliferative lupus glomerulonephritis treated with cyclophosphamide
Authors
Issue Date2006
PublisherExcerpta Medica, Inc. The Journal's web site is located at http://www.elsevier.com/locate/amj
Citation
American Journal Of Medicine, 2006, v. 119 n. 4, p. 355.e25-355.e33 How to Cite?
Abstract
PURPOSE: 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.
Persistent Identifierhttp://hdl.handle.net/10722/162954
ISSN
2013 Impact Factor: 5.302
ISI Accession Number ID
References

 

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
DC FieldValueLanguage
dc.contributor.authorMok, CCen_US
dc.contributor.authorYing, KYen_US
dc.contributor.authorNg, WLen_US
dc.contributor.authorLee, KWen_US
dc.contributor.authorTo, CHen_US
dc.contributor.authorLau, CSen_US
dc.contributor.authorWong, RWSen_US
dc.contributor.authorAu, TCen_US
dc.date.accessioned2012-09-05T05:25:50Z-
dc.date.available2012-09-05T05:25:50Z-
dc.date.issued2006en_US
dc.identifier.citationAmerican Journal Of Medicine, 2006, v. 119 n. 4, p. 355.e25-355.e33en_US
dc.identifier.issn0002-9343en_US
dc.identifier.urihttp://hdl.handle.net/10722/162954-
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.en_US
dc.languageengen_US
dc.publisherExcerpta Medica, Inc. The Journal's web site is located at http://www.elsevier.com/locate/amjen_US
dc.relation.ispartofAmerican Journal of Medicineen_US
dc.subject.meshAdministration, Oralen_US
dc.subject.meshAdulten_US
dc.subject.meshAmenorrhea - Chemically Induceden_US
dc.subject.meshAnalysis Of Varianceen_US
dc.subject.meshAnti-Inflammatory Agents - Therapeutic Useen_US
dc.subject.meshChinaen_US
dc.subject.meshCyclophosphamide - Administration & Dosage - Adverse Effectsen_US
dc.subject.meshDrug Therapy, Combinationen_US
dc.subject.meshFemaleen_US
dc.subject.meshHumansen_US
dc.subject.meshImmunosuppressive Agents - Administration & Dosage - Adverse Effectsen_US
dc.subject.meshInjections, Intravenousen_US
dc.subject.meshLogistic Modelsen_US
dc.subject.meshLupus Nephritis - Drug Therapy - Pathologyen_US
dc.subject.meshMaleen_US
dc.subject.meshOvary - Drug Effectsen_US
dc.subject.meshPrednisolone - Therapeutic Useen_US
dc.subject.meshPrognosisen_US
dc.subject.meshRetrospective Studiesen_US
dc.subject.meshRisk Assessmenten_US
dc.subject.meshRisk Factorsen_US
dc.subject.meshTime Factorsen_US
dc.subject.meshTreatment Failureen_US
dc.subject.meshTreatment Outcomeen_US
dc.titleLong-term outcome of diffuse proliferative lupus glomerulonephritis treated with cyclophosphamideen_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.doi10.1016/j.amjmed.2005.08.045en_US
dc.identifier.pmid16564783en_US
dc.identifier.scopuseid_2-s2.0-33645241849en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-33645241849&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume119en_US
dc.identifier.issue4en_US
dc.identifier.spage355.e25en_US
dc.identifier.epage355.e33en_US
dc.identifier.isiWOS:000236311800019-
dc.publisher.placeUnited Statesen_US
dc.identifier.scopusauthoridMok, CC=7102344226en_US
dc.identifier.scopusauthoridYing, KY=7005162138en_US
dc.identifier.scopusauthoridNg, WL=7401613401en_US
dc.identifier.scopusauthoridLee, KW=35788977700en_US
dc.identifier.scopusauthoridTo, CH=34968753300en_US
dc.identifier.scopusauthoridLau, CS=14035682100en_US
dc.identifier.scopusauthoridWong, RWS=34875928200en_US
dc.identifier.scopusauthoridAu, TC=7006646148en_US

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