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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
2012 Impact Factor: 2.783
2012 SCImago Journal Rankings: 0.985
 
DOIhttp://dx.doi.org/10.1191/0961203305lu2081oa
 
ISI Accession Number IDWOS:000228590200002
 
ReferencesReferences in Scopus
 
DC FieldValue
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
2012 Impact Factor: 2.783
2012 SCImago Journal Rankings: 0.985
 
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
 
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<description.abstract>The 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 &#177; 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 &lt; 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. &#169; 2005 Edward Arnold (Publishers) Ltd.</description.abstract>
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Author Affiliations
  1. The University of Hong Kong