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

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TitleLong-term outcome of patients with diffuse proliferative lupus nephritis treated with prednisolone and oral cyclophosphamide followed by azathioprine
AuthorsChan, TM1
Tse, KC1
Tang, CSO1
Lai, KN1
Li, FK1
KeywordsAzathioprine
Cyclophosphamide
Lupus nephritis
Issue Date2005
PublisherSage Publications Ltd. The Journal's web site is located at http://lup.sagepub.com
CitationLupus, 2005, v. 14 n. 4, p. 265-272 [How to Cite?]
DOI: http://dx.doi.org/10.1191/0961203305lu2081oa
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.
ISSN0961-2033
2011 Impact Factor: 2.337
2011 SCImago Journal Rankings: 0.226
DOIhttp://dx.doi.org/10.1191/0961203305lu2081oa
ISI Accession Number IDWOS:000228590200002
ReferencesReferences in Scopus
DC Field
Value
dc.contributor.authorChan, TM
dc.contributor.authorTse, KC
dc.contributor.authorTang, CSO
dc.contributor.authorLai, KN
dc.contributor.authorLi, FK
dc.date.accessioned2010-09-06T07:37:19Z
dc.date.available2010-09-06T07:37:19Z
dc.date.issued2005
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.
dc.description.natureLink_to_subscribed_fulltext
dc.identifier.citationLupus, 2005, v. 14 n. 4, p. 265-272 [How to Cite?]
DOI: http://dx.doi.org/10.1191/0961203305lu2081oa
dc.identifier.citeulike143047
dc.identifier.doihttp://dx.doi.org/10.1191/0961203305lu2081oa
dc.identifier.epage272
dc.identifier.hkuros99028
dc.identifier.isiWOS:000228590200002
dc.identifier.issn0961-2033
2011 Impact Factor: 2.337
2011 SCImago Journal Rankings: 0.226
dc.identifier.issue4
dc.identifier.openurl
dc.identifier.pmid15864912
dc.identifier.scopuseid_2-s2.0-15944410008
dc.identifier.spage265
dc.identifier.urihttp://hdl.handle.net/10722/77931
dc.identifier.volume14
dc.languageeng
dc.publisherSage Publications Ltd. The Journal's web site is located at http://lup.sagepub.com
dc.publisher.placeUnited Kingdom
dc.relation.ispartofLupus
dc.relation.referencesReferences in Scopus
dc.rightsLupus. Copyright © Sage Publications Ltd.
dc.subject.meshAdministration, Oral
dc.subject.meshAdult
dc.subject.meshAzathioprine - administration & dosage - adverse effects
dc.subject.meshCohort Studies
dc.subject.meshCreatinine - blood
dc.subject.meshCyclophosphamide - administration & dosage - adverse effects
dc.subject.meshDrug Therapy, Combination
dc.subject.meshFemale
dc.subject.meshHumans
dc.subject.meshImmunosuppressive Agents - administration & dosage - adverse effects
dc.subject.meshLupus Nephritis - drug therapy - physiopathology
dc.subject.meshMale
dc.subject.meshMiddle Aged
dc.subject.meshPrednisolone - administration & dosage
dc.subject.meshProspective Studies
dc.subject.meshTime Factors
dc.subject.meshTreatment Outcome
dc.subjectAzathioprine
dc.subjectCyclophosphamide
dc.subjectLupus nephritis
dc.titleLong-term outcome of patients with diffuse proliferative lupus nephritis treated with prednisolone and oral cyclophosphamide followed by azathioprine
dc.typeArticle
Author Affiliations
  1. The University of Hong Kong