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Article: Long-term outcome of patients with diffuse proliferative lupus nephritis treated with prednisolone and oral cyclophosphamide followed by azathioprine

TitleLong-term outcome of patients with diffuse proliferative lupus nephritis treated with prednisolone and oral cyclophosphamide followed by azathioprine
Authors
KeywordsAzathioprine
Cyclophosphamide
Lupus nephritis
Issue Date2005
PublisherSage Publications Ltd. The Journal's web site is located at http://lup.sagepub.com
Citation
Lupus, 2005, v. 14 n. 4, p. 265-272 How to Cite?
AbstractThe short-term outcome of patients with diffuse proliferative lupus nephritis (DPLN) has improved with advances in immunosuppressive treatment. However, the impact of different immunosuppressive regimens on long-term renal function remains to be defined. This prospective cohort study examined the long-term renal function and disease relapse in adults with biopsy-proven DPLN, significant proteinuria, and hypoalbuminemia, who had been treated with sequential immunosuppression comprising prednisolone and oral cyclophosphamide as induction followed by low-dose prednisolone and azathioprine as maintenance. Sixty-six patients with 68 episodes of DPLN were included, with follow-up of 91.7 ± 36.7 months. 82.4% achieved complete remission and 39.1% relapsed during follow-up. Patients in partial remission were at higher risk of relapse compared with those in complete remission (hazard ratio 6.2, P < 0.001). Serum creatinine remained stable over time (P = 0.931), while creatinine clearance showed a significant increase with time after treatment (P = 0.032). Three (4.4%) patients had doubling of baseline creatinine, but none reached end-stage renal failure or died. Univariate and mixed model analyses showed that the evolution of long-term renal function was significantly influenced by the chronicity score and creatinine clearance at baseline, and by the renal function at one year after treatment. These data demonstrate the efficacy of sequential immunosuppression in preserving renal function in most Chinese subjects with DPLN. The results also indicate that irreversible renal scarring (as reflected by baseline chronicity score), renal reserve (as reflected by renal function at baseline and one year), and an induction regimen that is effective in preserving the nephron mass are critical determinants of long-term renal outcome. © 2005 Edward Arnold (Publishers) Ltd.
Persistent Identifierhttp://hdl.handle.net/10722/77931
ISSN
2015 Impact Factor: 2.118
2015 SCImago Journal Rankings: 0.878
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorChan, TMen_HK
dc.contributor.authorTse, KCen_HK
dc.contributor.authorTang, CSOen_HK
dc.contributor.authorLai, KNen_HK
dc.contributor.authorLi, FKen_HK
dc.date.accessioned2010-09-06T07:37:19Z-
dc.date.available2010-09-06T07:37:19Z-
dc.date.issued2005en_HK
dc.identifier.citationLupus, 2005, v. 14 n. 4, p. 265-272en_HK
dc.identifier.issn0961-2033en_HK
dc.identifier.urihttp://hdl.handle.net/10722/77931-
dc.description.abstractThe short-term outcome of patients with diffuse proliferative lupus nephritis (DPLN) has improved with advances in immunosuppressive treatment. However, the impact of different immunosuppressive regimens on long-term renal function remains to be defined. This prospective cohort study examined the long-term renal function and disease relapse in adults with biopsy-proven DPLN, significant proteinuria, and hypoalbuminemia, who had been treated with sequential immunosuppression comprising prednisolone and oral cyclophosphamide as induction followed by low-dose prednisolone and azathioprine as maintenance. Sixty-six patients with 68 episodes of DPLN were included, with follow-up of 91.7 ± 36.7 months. 82.4% achieved complete remission and 39.1% relapsed during follow-up. Patients in partial remission were at higher risk of relapse compared with those in complete remission (hazard ratio 6.2, P < 0.001). Serum creatinine remained stable over time (P = 0.931), while creatinine clearance showed a significant increase with time after treatment (P = 0.032). Three (4.4%) patients had doubling of baseline creatinine, but none reached end-stage renal failure or died. Univariate and mixed model analyses showed that the evolution of long-term renal function was significantly influenced by the chronicity score and creatinine clearance at baseline, and by the renal function at one year after treatment. These data demonstrate the efficacy of sequential immunosuppression in preserving renal function in most Chinese subjects with DPLN. The results also indicate that irreversible renal scarring (as reflected by baseline chronicity score), renal reserve (as reflected by renal function at baseline and one year), and an induction regimen that is effective in preserving the nephron mass are critical determinants of long-term renal outcome. © 2005 Edward Arnold (Publishers) Ltd.en_HK
dc.languageengen_HK
dc.publisherSage Publications Ltd. The Journal's web site is located at http://lup.sagepub.comen_HK
dc.relation.ispartofLupusen_HK
dc.rightsLupus. Copyright © Sage Publications Ltd.en_HK
dc.subjectAzathioprineen_HK
dc.subjectCyclophosphamideen_HK
dc.subjectLupus nephritisen_HK
dc.subject.meshAdministration, Oralen_HK
dc.subject.meshAdulten_HK
dc.subject.meshAzathioprine - administration & dosage - adverse effectsen_HK
dc.subject.meshCohort Studiesen_HK
dc.subject.meshCreatinine - blooden_HK
dc.subject.meshCyclophosphamide - administration & dosage - adverse effectsen_HK
dc.subject.meshDrug Therapy, Combinationen_HK
dc.subject.meshFemaleen_HK
dc.subject.meshHumansen_HK
dc.subject.meshImmunosuppressive Agents - administration & dosage - adverse effectsen_HK
dc.subject.meshLupus Nephritis - drug therapy - physiopathologyen_HK
dc.subject.meshMaleen_HK
dc.subject.meshMiddle Ageden_HK
dc.subject.meshPrednisolone - administration & dosageen_HK
dc.subject.meshProspective Studiesen_HK
dc.subject.meshTime Factorsen_HK
dc.subject.meshTreatment Outcomeen_HK
dc.titleLong-term outcome of patients with diffuse proliferative lupus nephritis treated with prednisolone and oral cyclophosphamide followed by azathioprineen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0961-2033&volume=14&issue=4&spage=265&epage=272&date=2005&atitle=Long-term+outcome+of+patients+with+diffuse+proliferative+lupus+nephritis+treated+with+prednisolone+and+oral+cyclophosphamide+followed+by+azathioprine.en_HK
dc.identifier.emailChan, TM: dtmchan@hku.hken_HK
dc.identifier.emailLai, KN: knlai@hku.hken_HK
dc.identifier.authorityChan, TM=rp00394en_HK
dc.identifier.authorityLai, KN=rp00324en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1191/0961203305lu2081oaen_HK
dc.identifier.pmid15864912-
dc.identifier.scopuseid_2-s2.0-15944410008en_HK
dc.identifier.hkuros99028en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-15944410008&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume14en_HK
dc.identifier.issue4en_HK
dc.identifier.spage265en_HK
dc.identifier.epage272en_HK
dc.identifier.isiWOS:000228590200002-
dc.publisher.placeUnited Kingdomen_HK
dc.identifier.scopusauthoridChan, TM=7402687700en_HK
dc.identifier.scopusauthoridTse, KC=7102609864en_HK
dc.identifier.scopusauthoridTang, CSO=8681865300en_HK
dc.identifier.scopusauthoridLai, KN=7402135706en_HK
dc.identifier.scopusauthoridLi, FK=55210612400en_HK
dc.identifier.citeulike143047-

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