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Article: Sequential therapy for diffuse proliferative and membranous lupus nephritis: Cyclophosphamide and prednisolone followed by azathioprine and prednisolone

TitleSequential therapy for diffuse proliferative and membranous lupus nephritis: Cyclophosphamide and prednisolone followed by azathioprine and prednisolone
Authors
KeywordsCyclophosphamide
Lupus nephritis
Systemic lupus erythematosus
Issue Date1995
PublisherS Karger AG. The Journal's web site is located at http://www.karger.com/NEF
Citation
Nephron, 1995, v. 71 n. 3, p. 321-327 How to Cite?
AbstractA retrospective single-center cohort study was conducted on 35 patients with diffuse proliferative (WHO type IV) and/or membranous (type V) lupus nephritis (22 with type IV, 6 with type V, and 7 with type IV plus V) who had been treated with a sequential regimen comprising prednisolone and cyclophosphamide during active disease, followed by low-dose prednisolone and azathioprine maintenance. The follow-up period was 33.2 ± 4.5 months. At presentation, 32 (91.4%) patients were nephrotic, and an abnormal serum creatinine level was noted in 14 (48.3%) patients with type IV changes. Cyclophosphamide was given for 26.8 ± 2.8 weeks. 33 (94.3%) patients achieved complete or partial renal remissions: 77.3 and 22.7% of the type IV patients, 16.7 and 66.6% of the type V patients, and 14.3 and 71.4% of the type IV plus V patients, respectively (p < 0.0001 for type IV versus type V and for type IV versus type IV plus V). The duration of therapy before renal remissions and normalization of C3 were attained was similar among the three groups of patients. Disease relapse occurred in 4 (18.2%) of 22 type IV patients and in 1 of the 5 type V patients in remission. Mortality was not observed, and none of the patients had an increase in serum creatinine level to double the baseline value. Adverse effects related to therapy included: hair loss (42.9%), transient amenorrhea (53.6%), leukopenia (11.4%), febrile episodes (14.3%), and herpes zoster (28.6%). We conclude that sequential use of prednisolone and cyclophosphamide followed by low-dose prednisolone and azathioprine can achieve favorable therapeutic results in the majority of patients with diffuse proliferative and/or membranous lupus nephritis, without excessive toxicities.
Persistent Identifierhttp://hdl.handle.net/10722/78430
ISSN
2004 Impact Factor: 1.462
2006 SCImago Journal Rankings: 0.715
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorChan, TMen_HK
dc.contributor.authorLi, FKen_HK
dc.contributor.authorWong, RWSen_HK
dc.contributor.authorWong, KLen_HK
dc.contributor.authorChang, KWen_HK
dc.contributor.authorChang, IKPen_HK
dc.date.accessioned2010-09-06T07:42:48Z-
dc.date.available2010-09-06T07:42:48Z-
dc.date.issued1995en_HK
dc.identifier.citationNephron, 1995, v. 71 n. 3, p. 321-327en_HK
dc.identifier.issn0028-2766en_HK
dc.identifier.urihttp://hdl.handle.net/10722/78430-
dc.description.abstractA retrospective single-center cohort study was conducted on 35 patients with diffuse proliferative (WHO type IV) and/or membranous (type V) lupus nephritis (22 with type IV, 6 with type V, and 7 with type IV plus V) who had been treated with a sequential regimen comprising prednisolone and cyclophosphamide during active disease, followed by low-dose prednisolone and azathioprine maintenance. The follow-up period was 33.2 ± 4.5 months. At presentation, 32 (91.4%) patients were nephrotic, and an abnormal serum creatinine level was noted in 14 (48.3%) patients with type IV changes. Cyclophosphamide was given for 26.8 ± 2.8 weeks. 33 (94.3%) patients achieved complete or partial renal remissions: 77.3 and 22.7% of the type IV patients, 16.7 and 66.6% of the type V patients, and 14.3 and 71.4% of the type IV plus V patients, respectively (p < 0.0001 for type IV versus type V and for type IV versus type IV plus V). The duration of therapy before renal remissions and normalization of C3 were attained was similar among the three groups of patients. Disease relapse occurred in 4 (18.2%) of 22 type IV patients and in 1 of the 5 type V patients in remission. Mortality was not observed, and none of the patients had an increase in serum creatinine level to double the baseline value. Adverse effects related to therapy included: hair loss (42.9%), transient amenorrhea (53.6%), leukopenia (11.4%), febrile episodes (14.3%), and herpes zoster (28.6%). We conclude that sequential use of prednisolone and cyclophosphamide followed by low-dose prednisolone and azathioprine can achieve favorable therapeutic results in the majority of patients with diffuse proliferative and/or membranous lupus nephritis, without excessive toxicities.en_HK
dc.languageengen_HK
dc.publisherS Karger AG. The Journal's web site is located at http://www.karger.com/NEFen_HK
dc.relation.ispartofNephronen_HK
dc.rightsNephron. Copyright © S Karger AG.en_HK
dc.subjectCyclophosphamideen_HK
dc.subjectLupus nephritisen_HK
dc.subjectSystemic lupus erythematosusen_HK
dc.subject.meshAdulten_HK
dc.subject.meshAzathioprine - therapeutic useen_HK
dc.subject.meshCohort Studiesen_HK
dc.subject.meshCreatinine - blooden_HK
dc.subject.meshCyclophosphamide - therapeutic useen_HK
dc.subject.meshDrug Therapy, Combinationen_HK
dc.subject.meshFemaleen_HK
dc.subject.meshFollow-Up Studiesen_HK
dc.subject.meshHumansen_HK
dc.subject.meshImmunosuppressive Agents - therapeutic useen_HK
dc.subject.meshLupus Nephritis - classification - drug therapyen_HK
dc.subject.meshMaleen_HK
dc.subject.meshNephritisen_HK
dc.subject.meshPrednisolone - therapeutic useen_HK
dc.subject.meshProteinuriaen_HK
dc.subject.meshRetrospective Studiesen_HK
dc.subject.meshTreatment Failureen_HK
dc.subject.meshTreatment Outcomeen_HK
dc.titleSequential therapy for diffuse proliferative and membranous lupus nephritis: Cyclophosphamide and prednisolone followed by azathioprine and prednisoloneen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0028-2766&volume=71&spage=321&epage=327&date=1995&atitle=Sequential+therapy+for+diffuse+proliferative+and+membranous+lupus+nephritis:+cyclophosphamide+and+prednisolone+followed+by+azathioprine+and+prednisoloneen_HK
dc.identifier.emailChan, TM:dtmchan@hku.hken_HK
dc.identifier.emailChang, KW:hrmtckw@hku.hken_HK
dc.identifier.authorityChan, TM=rp00394en_HK
dc.identifier.authorityChang, KW=rp00330en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.pmid8569982-
dc.identifier.scopuseid_2-s2.0-0028862067en_HK
dc.identifier.hkuros11291en_HK
dc.identifier.volume71en_HK
dc.identifier.issue3en_HK
dc.identifier.spage321en_HK
dc.identifier.epage327en_HK
dc.identifier.isiWOS:A1995TC15800009-
dc.publisher.placeSwitzerlanden_HK
dc.identifier.scopusauthoridChan, TM=7402687700en_HK
dc.identifier.scopusauthoridLi, FK=55210612400en_HK
dc.identifier.scopusauthoridWong, RWS=34875928200en_HK
dc.identifier.scopusauthoridWong, KL=7404759833en_HK
dc.identifier.scopusauthoridChang, KW=16444133100en_HK
dc.identifier.scopusauthoridChang, IKP=7201741960en_HK

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