Clinical approach to lupus nephritis: Recent advances (original) (raw)
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SUN-429 Renal Involvement in Sle: Kenya Perspective
Kidney International Reports, 2020
Renal involvement in systemic lupus is present in approximately 60% of adults. It remains one of the most severe complications of systemic lupus, influencing treatment and prognosis. It is a glomerular disease but tubulointerstitial and vascular involvement can play an aggravating role and must be evaluated. Thus, we conducted this study with the aim of determining the epidemiological, clinical, biological, histological, therapeutic, evolutive and prognostic aspects of lupus nephritis and the prognostic impact of tubulointerstitial lesions associated. Methods: it was a descriptive retrospective study for an analytical purpose over a period of six years from January 1, 2010 to December 30, 2016 performed in the nephrology department at Aristide Le Dantec University Hospital. Patients aged 17 years and older with systemic lupus and lupus nephritis confirmed by renal biopsy were included. Results: We included 99 patients with an average age of 33.33 AE 10.44 years. Our series included 13 men and 86 women, a sex-ratio of 0.15. Lupus was known in 53% of patients. Among the renal signs, edema of lower limbs were present in 55.55% of patients and HBP found in 39% of patients. Proteinuria was present in 40% of patients, hematuria in 26% and leukocyturia in 11% of patients. Extra-renal signs were dermatologic in 45% of patients and rheumatologic in 35% of patients. The average serum creatinine was 23.48 AE 32 mg / l with an average eGFR of 87.96 AE 66.13ml / min / 1.73m 2. Renal function was altered in 33% of patients. Anti-nuclear antibodies were positive in 15 patients and Anti-native DNA antibodies positive in 22 patients. Class V lupus nephritis was 68% representative, associated with class II in 4 patients, class III in 25 patients, and class IV in 9 patients. Class III was found in 35 cases, Class IV in 17 cases, Classes I and II in 4 cases each. Tubular atrophy was present in 38% of patients and necrosis was found in 11% of patients. A cellular infiltrate at the interstitial level was noted in 45% of patients. Interstitial fibrosis was present in 41% of patients. At the induction phase, 56% of patients were on Prednisone. 53% under Methylprednisolone for 3 days followed by an oral Prednisone. And 71% of patients were immunosuppressed whose 68% under cyclophosphamide, 25% under mycophenolate mofetil and 7% under azathioprine. In the maintenance phase, all patients were on corticosteroids. Immunosuppressive drugs were maintained in 64% of patients. Among them, 40% were on cyclophosphamide, 32% on MMF, 16% on Azathioprine and 12% on unspecified treatment. Among of the 99 patients, 31 were followed for 6 months, 6 of whom 6 were lost. Of these 31 patients, 6 were in complete remission, 10 in incomplete remission, 9 patients had resistance. Two CKDs were noted as well as one relapse. A correlation was found between class IV and the presence of hypertension, renal failure and hematuria. There was also a statistically significant relationship between class V and the presence of hypertension, as well as tubulointerstitial achievement and impaired renal function. Conclusions: Lupus nephritis is common in our exercise context. The most common pathological lesion is membranous glomerulonephritis, often associated with proliferative glomerulonephritis. The occurrence of renal failure was correlated with proliferative classes as well as with tubulointerstitial involvement.
An Update on Systemic Lupus Erythematosus-Related Kidney Disease
NEPHROLOGY Rounds, 2006
Renal disease is a common complication of systemic lupus erythematosus (SLE). It can affect the kidney as glomerulonephritis, tubulointerstitial nephritis, and antiphospholipid antibody syndrome (APS), manifestations that may occur alone or together. Glomerulonephritis (usually synonymous with the term, "lupus nephritis") is the most common and best-studied form of kidney involvement. Traditionally, severe forms of lupus glomerulonephritis have been treated with glucocorticoids plus prolonged courses of cyclophosphamide. However, recent studies with newer, less toxic regimens have yielded encouraging results. This issue of Nephrology Rounds reviews the types of kidney disease that can affect SLE patients and how these conditions are treated.
Background: Systemic Lupus Erythematosus (SLE) is a multisystem autoimmune disorder with a broad spectrum of clinical presentations encompassing almost all organs and tissues. Renal disease in SLE carries a significant morbidity and mortality. Despite treatment advances, up to 26% of patients with lupus Nephritis (LN) still develop End Stage Renal Disease (ESRD). Objectives: To specify the best lines of management for SLE, those directly influence the outcome of SLE patients in our unit, Also to follow up and compare between the favorable and the unfavorable SLE activity outcomes. Subjects and methods: Our study was an interventional non randomized clinical trial conducted at Nephrology Unit, Internal Medicine Department, Zagazig University Hospitals, including 64 adult participants diagnosed with SLE who gave their informed consent. All subjects were divided according to their renal biopsy into three groups, the 1st group was 21 patients (2 males and 19 females) with class III (LN), the 2nd group was 28 patients (3 males and 25 females) with class IV (LN) and the 3 rd group was 15 patients (2 males and 13 females) with class V-proliferative (LN), each group was subdivided into 2 sub-groups according to the induction treatment used that was either oral mycophenolate mofetil (MMF) or iv cyclophosphamide (CYC) . Results: (LN) class IV is the commonest, proteinuria was higher in class V-proliferative (V+ III/IV) (LN) group than other 2 groups and serum albumin was lower than the other 2 groups. The rates of response have been 31.3 % for complete remission (CR), 45.3% for partial remission (PR) , 20.3 % of patients reported treatment failure, 10.9 % developed ESRD while 17.2% died .The highest rate of treatment response either CR or PR was noticed with class III (LN) ,While the highest rate of non responders was noticed with class IV (LN) & class (V-III/IV) (LN). MMF showed superiority over CYC.
American Journal of Nephrology, 2005
were under drug treatment; of the remaining, 30 had an nrSLEDAI of 1 0 totaling 48 patients (84%) initially labeled as active. An apparent activity was also present in 21 controls (37%). Of those, 19 had an nrSLEDAI of ! 4. With a cutoff of 6 4, fi gures in each group would be 49 and 4%. Under this criterion, age was the only signifi cant predictor of fl are in our SLE ESRD population in a multivariate logistic regression model. Activity remained high in patients who were on dialysis for 1 5 years (7/18, 39%). Conclusion: SLE accounted for 1.8% of our ESRD patients. Application of SLEDAI to dialysis patients may require consideration of confounding factors related to the ESRD state. Even with a score of 6 4 as a cutoff, SLE activity in dialysis patients was high (49%) and long-lasting. Age was the major determinant of fl are.
Nephrology Dialysis Transplantation, 2011
Background. B cells play a central role in systemic lupus erythematosus (SLE). Rituximab is expected to induce apoptosis of all the CD20-positive B cells. A proportion of patients are refractory or intolerant to standard immunosup-pression. These are candidate to new therapeutic options. Methods. Eight patients [six women, two men, mean age 41-year-old (27-51), with severe multiorgan involvement (kidney, skin, nervous system, polyarthritis, polyserositis, antiphospho-lipid antibody syndrome)] were considered eligible for an in-tensive combination therapy including rituximab. Rituximab was administered (dose 375 mg/m 2 ) on Days #2, 8, 15 and 22. Two more doses were administered 1 and 2 months following the last weekly infusion. This treatment was combined with two pulses of 750 mg cyclophosphamide (Days #4 and 17) and three pulses of 15 mg/kg (Days #1, 4 and 8) methylpredniso-lone followed by oral prednisone, 50 mg for 2 weeks rapidly tapered until 5 mg in 2 months. Response was evaluated by assessing the changes in clinical signs and symptoms [Sys-temic Lupus Erythematosus Disease Activity Index (SLEDAI score)] and laboratory parameters for at least 12 months. Results. Levels of erythrocyte sedimentation rate and anti-double-strand DNA antibodies significantly decreased (P < 0.01 at 12 months), whereas C3 and mainly C4 values increased at 6 months (P < 0.01 for C4). Proteinuria im-proved in the cases with renal involvement (P < 0.01 at 3, 6 and 12 months). SLEDAI score improved moving from the mean 17.3 (12-27) before therapy to 3.1 (1-5) after ritux-imab treatment. Constitutional symptoms including arthral-gia, weakness and fever disappeared in all the previously affected patients; paresthesia improved in the four patients with polyneuropathy and skin lesions gradually resolved in the patients with necrotizing skin ulcers at presentation. Drug side effects were negligible. Conclusions. Long-lasting remissions were obtained in patients with severe SLE and major organ involvement by this intensive administration of rituximab combined with low doses of intravenous cyclophosphamide and methylprednisolone pulses followed by a rapid tapering of prednisone to 5 mg/day as a sole maintenance therapy.