|
Sign In to gain access to subscriptions and/or personal tools.
|
Long-term outcome of patients with diffuse proliferative lupus nephritis treated with prednisolone and oral cyclophosphamide followed by azathioprine
T M Chan
Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, dtmchan{at}hku.hk
K C Tse
Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
C SO Tang
Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
K N Lai
Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
F K Li
Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
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 + 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.
Key Words: azathioprine • cyclophosphamide • lupus nephritis
Lupus, Vol. 14, No. 4,
265-272 (2005)
DOI: 10.1191/0961203305lu2081oa
 CiteULike  Complore  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter What's this?
This article has been cited by other articles:
|
|
|
|
 
A. McKinley, E. Park, D. Spetie, K. V. Hackshaw, S. Nagaraja, L. A. Hebert, and B. H. Rovin
Oral Cyclophosphamide for Lupus Glomerulonephritis: An Underused Therapeutic Option
Clin. J. Am. Soc. Nephrol.,
November 1, 2009;
4(11):
1754 - 1760.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F Yu, Y Tan, L-H Wu, S-N Zhu, G Liu, and M-H Zhao
Class IV-G and IV-S lupus nephritis in Chinese patients: a large cohort study from a single center
Lupus,
October 1, 2009;
18(12):
1073 - 1081.
[Abstract]
[PDF]
|
|
|
|
|
|
|
F. Yu, Y. Tan, and M.-H. Zhao
Lupus nephritis combined with renal injury due to thrombotic thrombocytopaenic purpura-haemolytic uraemic syndrome
Nephrol. Dial. Transplant.,
August 23, 2009;
(2009)
gfp421v1.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G K Bertsias, J P A Ioannidis, J Boletis, S Bombardieri, R Cervera, C Dostal, J Font, I M Gilboe, F Houssiau, T Huizinga, et al.
EULAR points to consider for conducting clinical trials in systemic lupus erythematosus: literature based evidence for the selection of endpoints
Ann Rheum Dis,
April 1, 2009;
68(4):
477 - 483.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. D. ASKANASE, D. J. WALLACE, M. H. WEISMAN, C.-E TSENG, L. BERNSTEIN, H. M. BELMONT, E. SEIDMAN, M. ISHIMORI, P. M. IZMIRLY, and J. P. BUYON
Use of Pharmacogenetics, Enzymatic Phenotyping, and Metabolite Monitoring to Guide Treatment with Azathioprine in Patients with Systemic Lupus Erythematosus
J Rheumatol,
January 1, 2009;
36(1):
89 - 95.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Chan
Mycophenolate mofetil in the treatment of lupus nephritis - 7 years on
Lupus,
July 1, 2008;
17(7):
617 - 621.
[PDF]
|
|
|
|
|
|
|
G Ferraccioli and G Romano
Renal interstitial cells, proteinuria and progression of lupus nephritis: new frontiers for old factors
Lupus,
June 1, 2008;
17(6):
533 - 540.
[Abstract]
[PDF]
|
|
|
|
|
|
|
Y. E. Chen, S. M. Korbet, R. S. Katz, M. M. Schwartz, E. J. Lewis, and for the Collaborative Study Group
Value of a Complete or Partial Remission in Severe Lupus Nephritis
Clin. J. Am. Soc. Nephrol.,
January 1, 2008;
3(1):
46 - 53.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K C Tse, M F Lam, S C. Tang, C S. Tang, and T M Chan
A pilot study on tacrolimus treatment in membranous or quiescent lupus nephritis with proteinuria resistant to angiotensin inhibition or blockade
Lupus,
January 1, 2007;
16(1):
46 - 51.
[Abstract]
[PDF]
|
|
|
|
|
|
|
M. E Moretti, Z. Verjee, S. Ito, and G. Koren
Breast-Feeding During Maternal Use of Azathioprine
Ann. Pharmacother.,
December 1, 2006;
40(12):
2269 - 2272.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K C Tse, C S. Tang, W I Lio, M F Lam, and T M Chan
Quality of life comparison between corticosteroidand-mycofenolate mofetil and corticosteroidand-oral cyclophosphamide in the treatment of severe lupus nephritis
Lupus,
June 1, 2006;
15(6):
371 - 379.
[Abstract]
[PDF]
|
|
|
|
|
|
|
C. Grootscholten and J. H. M. Berden
Discontinuation of immunosuppression in proliferative lupus nephritis: is it possible?
Nephrol. Dial. Transplant.,
June 1, 2006;
21(6):
1465 - 1469.
[Full Text]
[PDF]
|
|
|
|
|
|
|
K C Tse, F K Li, S Tang, C S-O Tang, K N Lai, and T M Chan
Angiotensin inhibition or blockade for the treatment of patients with quiescent lupus nephritis and persistent proteinuria
Lupus,
December 1, 2005;
14(12):
947 - 952.
[Abstract]
[PDF]
|
|
|
|
|
|
|
G G Illei
On the road to the optimal treatment of lupus nephritis: are we there yet?
Lupus,
April 1, 2005;
14(4):
263 - 264.
[PDF]
|
|
|
|
|
|
|
T.-M. Chan, K.-C. Tse, C. S.-O. Tang, M.-Y. Mok, F.-K. Li, and for the Hong Kong Nephrology Study Group
Long-Term Study of Mycophenolate Mofetil as Continuous Induction and Maintenance Treatment for Diffuse Proliferative Lupus Nephritis
J. Am. Soc. Nephrol.,
April 1, 2005;
16(4):
1076 - 1084.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
