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Article: Predictors and outcome of renal flares after successful cyclophosphamide treatment for diffuse proliferative lupus glomerulonephritis

TitlePredictors and outcome of renal flares after successful cyclophosphamide treatment for diffuse proliferative lupus glomerulonephritis
Authors
Issue Date2004
PublisherJohn Wiley & Sons, Inc. The Journal's web site is located at http://www.interscience.wiley.com/jpages/0004-3591/
Citation
Arthritis And Rheumatism, 2004, v. 50 n. 8, p. 2559-2568 How to Cite?
AbstractObjective. To study the incidence, predictors, and outcome of renal flares after successful cyclophosphamide (CYC) treatment for diffuse proliferative glomerulonephritis (DPGN) in patients with systemic lupus erythematosus (SLE). Methods. Between 1988 and 2001, patients with biopsy-proven SLE DPGN who were treated initially with prednisone and CYC were studied. Those who responded to CYC were followed up for the occurrence of renal flares. The cumulative risk, predictors, and outcome of renal flares were evaluated. Results. We studied 189 patients (167 women; and 22 men) with SLE DPGN. All were initially treated with prednisone and CYC (49% orally; 51% by intravenous pulse). At the last dose of CYC, 103 patients (55%) and 52 patients (28%) had achieved complete and partial renal responses, respectively. Azathioprine (AZA) was given as maintenance therapy in 117 patients (75%). After a mean followup of 96.5 months, 59 patients (38%) experienced renal flares (42% nephritic; 58% proteinuric). The median time to relapse was 32 months. The cumulative risk of renal flare was 28% at 36 months and 44% at 60 months. Independent predictors of nephritic flares were persistently low C3 levels after CYC treatment and absence of AZA maintenance therapy. At the last clinic visit, 16 patients (10.3%) had developed doubling of the serum creatinine level (cumulative risk of creatinine doubling 7.4% at 5 years after renal biopsy and 14.3% at 10 years). Ten patients (6.5%) developed end-stage renal disease (ESRD). Renal survival rates at 5 and 10 years were 94.9% and 87.5%, respectively. Increasing histologic chronicity scores, failure to achieve complete response, persistent hypertension after CYC treatment, and nephritic renal flares were unfavorable factors for doubling of the serum creatinine level and for ESRD by univariate analysis. The occurrence of nephritic flares was the only predictor of creatinine doubling by Cox regression analysis. Conclusion. In patients with SLE DPGN, renal flares are common despite initial responses to CYC. Nephritic renal flares are associated with a decline in renal function. Maintenance therapy with AZA reduces, but does not completely prevent, renal flares. More effective maintenance treatment for SLE DPGN after an initial response to CYC should be evaluated.
Persistent Identifierhttp://hdl.handle.net/10722/76823
ISSN
2014 Impact Factor: 7.764
2014 SCImago Journal Rankings: 2.103
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorMok, CCen_HK
dc.contributor.authorYing, KYen_HK
dc.contributor.authorTang, Sen_HK
dc.contributor.authorLeung, CYen_HK
dc.contributor.authorLee, KWen_HK
dc.contributor.authorNg, WLen_HK
dc.contributor.authorWong, RWSen_HK
dc.contributor.authorLau, CSen_HK
dc.date.accessioned2010-09-06T07:25:18Z-
dc.date.available2010-09-06T07:25:18Z-
dc.date.issued2004en_HK
dc.identifier.citationArthritis And Rheumatism, 2004, v. 50 n. 8, p. 2559-2568en_HK
dc.identifier.issn0004-3591en_HK
dc.identifier.urihttp://hdl.handle.net/10722/76823-
dc.description.abstractObjective. To study the incidence, predictors, and outcome of renal flares after successful cyclophosphamide (CYC) treatment for diffuse proliferative glomerulonephritis (DPGN) in patients with systemic lupus erythematosus (SLE). Methods. Between 1988 and 2001, patients with biopsy-proven SLE DPGN who were treated initially with prednisone and CYC were studied. Those who responded to CYC were followed up for the occurrence of renal flares. The cumulative risk, predictors, and outcome of renal flares were evaluated. Results. We studied 189 patients (167 women; and 22 men) with SLE DPGN. All were initially treated with prednisone and CYC (49% orally; 51% by intravenous pulse). At the last dose of CYC, 103 patients (55%) and 52 patients (28%) had achieved complete and partial renal responses, respectively. Azathioprine (AZA) was given as maintenance therapy in 117 patients (75%). After a mean followup of 96.5 months, 59 patients (38%) experienced renal flares (42% nephritic; 58% proteinuric). The median time to relapse was 32 months. The cumulative risk of renal flare was 28% at 36 months and 44% at 60 months. Independent predictors of nephritic flares were persistently low C3 levels after CYC treatment and absence of AZA maintenance therapy. At the last clinic visit, 16 patients (10.3%) had developed doubling of the serum creatinine level (cumulative risk of creatinine doubling 7.4% at 5 years after renal biopsy and 14.3% at 10 years). Ten patients (6.5%) developed end-stage renal disease (ESRD). Renal survival rates at 5 and 10 years were 94.9% and 87.5%, respectively. Increasing histologic chronicity scores, failure to achieve complete response, persistent hypertension after CYC treatment, and nephritic renal flares were unfavorable factors for doubling of the serum creatinine level and for ESRD by univariate analysis. The occurrence of nephritic flares was the only predictor of creatinine doubling by Cox regression analysis. Conclusion. In patients with SLE DPGN, renal flares are common despite initial responses to CYC. Nephritic renal flares are associated with a decline in renal function. Maintenance therapy with AZA reduces, but does not completely prevent, renal flares. More effective maintenance treatment for SLE DPGN after an initial response to CYC should be evaluated.en_HK
dc.languageengen_HK
dc.publisherJohn Wiley & Sons, Inc. The Journal's web site is located at http://www.interscience.wiley.com/jpages/0004-3591/en_HK
dc.relation.ispartofArthritis and Rheumatismen_HK
dc.rightsArthritis & Rheumatism. Copyright © John Wiley & Sons, Inc.en_HK
dc.subject.meshAdulten_HK
dc.subject.meshAzathioprine - therapeutic useen_HK
dc.subject.meshBiopsyen_HK
dc.subject.meshComplement C3 - analysisen_HK
dc.subject.meshCreatinine - blooden_HK
dc.subject.meshCyclophosphamide - administration & dosage - therapeutic useen_HK
dc.subject.meshFemaleen_HK
dc.subject.meshHumansen_HK
dc.subject.meshKidney - pathologyen_HK
dc.subject.meshKidney Failure, Chronic - etiologyen_HK
dc.subject.meshLupus Nephritis - drug therapy - pathologyen_HK
dc.subject.meshMaleen_HK
dc.subject.meshPrednisone - therapeutic useen_HK
dc.subject.meshRecurrenceen_HK
dc.subject.meshTreatment Outcomeen_HK
dc.titlePredictors and outcome of renal flares after successful cyclophosphamide treatment for diffuse proliferative lupus glomerulonephritisen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0004-3591&volume=50&spage=2559&epage=2568&date=2004&atitle=Predictors+and+outcome+of+renal+flares+after+successful+cyclophosphamide+treatment+for+diffuse+proliferative+lupus+glomerulonephritisen_HK
dc.identifier.emailTang, S:scwtang@hku.hken_HK
dc.identifier.emailLau, CS:cslau@hku.hken_HK
dc.identifier.authorityTang, S=rp00480en_HK
dc.identifier.authorityLau, CS=rp01348en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1002/art.20364en_HK
dc.identifier.pmid15334470en_HK
dc.identifier.scopuseid_2-s2.0-4043168554en_HK
dc.identifier.hkuros137163en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-4043168554&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume50en_HK
dc.identifier.issue8en_HK
dc.identifier.spage2559en_HK
dc.identifier.epage2568en_HK
dc.identifier.isiWOS:000223185500023-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridMok, CC=7102344226en_HK
dc.identifier.scopusauthoridYing, KY=7005162138en_HK
dc.identifier.scopusauthoridTang, S=7403437082en_HK
dc.identifier.scopusauthoridLeung, CY=34979911800en_HK
dc.identifier.scopusauthoridLee, KW=35788977700en_HK
dc.identifier.scopusauthoridNg, WL=7401613401en_HK
dc.identifier.scopusauthoridWong, RWS=34875928200en_HK
dc.identifier.scopusauthoridLau, CS=14035682100en_HK

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