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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?
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.
Persistent Identifierhttp://hdl.handle.net/10722/162954
ISSN
2014 Impact Factor: 5.003
ISI Accession Number ID
References

 

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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