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Article: Predictors and outcome of renal flares after successful cyclophosphamide treatment for diffuse proliferative lupus glomerulonephritis
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TitlePredictors and outcome of renal flares after successful cyclophosphamide treatment for diffuse proliferative lupus glomerulonephritis
 
AuthorsMok, CC2 2
Ying, KY1
Tang, S4
Leung, CY4
Lee, KW3
Ng, WL4
Wong, RWS5
Lau, CS5
 
Issue Date2004
 
PublisherJohn Wiley & Sons, Inc. The Journal's web site is located at http://www.interscience.wiley.com/jpages/0004-3591/
 
CitationArthritis And Rheumatism, 2004, v. 50 n. 8, p. 2559-2568 [How to Cite?]
DOI: http://dx.doi.org/10.1002/art.20364
 
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.
 
ISSN0004-3591
2012 Impact Factor: 7.477
2012 SCImago Journal Rankings: 3.012
 
DOIhttp://dx.doi.org/10.1002/art.20364
 
ISI Accession Number IDWOS:000223185500023
 
ReferencesReferences in Scopus
 
DC FieldValue
dc.contributor.authorMok, CC
 
dc.contributor.authorYing, KY
 
dc.contributor.authorTang, S
 
dc.contributor.authorLeung, CY
 
dc.contributor.authorLee, KW
 
dc.contributor.authorNg, WL
 
dc.contributor.authorWong, RWS
 
dc.contributor.authorLau, CS
 
dc.date.accessioned2010-09-06T07:25:18Z
 
dc.date.available2010-09-06T07:25:18Z
 
dc.date.issued2004
 
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.
 
dc.description.natureLink_to_subscribed_fulltext
 
dc.identifier.citationArthritis And Rheumatism, 2004, v. 50 n. 8, p. 2559-2568 [How to Cite?]
DOI: http://dx.doi.org/10.1002/art.20364
 
dc.identifier.doihttp://dx.doi.org/10.1002/art.20364
 
dc.identifier.epage2568
 
dc.identifier.hkuros137163
 
dc.identifier.isiWOS:000223185500023
 
dc.identifier.issn0004-3591
2012 Impact Factor: 7.477
2012 SCImago Journal Rankings: 3.012
 
dc.identifier.issue8
 
dc.identifier.openurl
 
dc.identifier.pmid15334470
 
dc.identifier.scopuseid_2-s2.0-4043168554
 
dc.identifier.spage2559
 
dc.identifier.urihttp://hdl.handle.net/10722/76823
 
dc.identifier.volume50
 
dc.languageeng
 
dc.publisherJohn Wiley & Sons, Inc. The Journal's web site is located at http://www.interscience.wiley.com/jpages/0004-3591/
 
dc.publisher.placeUnited States
 
dc.relation.ispartofArthritis and Rheumatism
 
dc.relation.referencesReferences in Scopus
 
dc.rightsArthritis & Rheumatism. Copyright © John Wiley & Sons, Inc.
 
dc.subject.meshAdult
 
dc.subject.meshAzathioprine - therapeutic use
 
dc.subject.meshBiopsy
 
dc.subject.meshComplement C3 - analysis
 
dc.subject.meshCreatinine - blood
 
dc.subject.meshCyclophosphamide - administration & dosage - therapeutic use
 
dc.subject.meshFemale
 
dc.subject.meshHumans
 
dc.subject.meshKidney - pathology
 
dc.subject.meshKidney Failure, Chronic - etiology
 
dc.subject.meshLupus Nephritis - drug therapy - pathology
 
dc.subject.meshMale
 
dc.subject.meshPrednisone - therapeutic use
 
dc.subject.meshRecurrence
 
dc.subject.meshTreatment Outcome
 
dc.titlePredictors and outcome of renal flares after successful cyclophosphamide treatment for diffuse proliferative lupus glomerulonephritis
 
dc.typeArticle
 
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<contributor.author>Ying, KY</contributor.author>
<contributor.author>Tang, S</contributor.author>
<contributor.author>Leung, CY</contributor.author>
<contributor.author>Lee, KW</contributor.author>
<contributor.author>Ng, WL</contributor.author>
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<subject.mesh>Prednisone - therapeutic use</subject.mesh>
<subject.mesh>Recurrence</subject.mesh>
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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