Cardiovascular risk factors and the long-term outcome of lupus nephritis

Font, José A.; Ramos‐Casals, M.; Cervera, Ricard; Garcı́a-Carrasco, Mario; Torrás, A; Sisó, Antoni; Darnell, A; Ingelmo, M

doi:10.1093/qjmed/94.1.19

Cited by 78 publications

(55 citation statements)

References 37 publications

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“…The association between hypertension and endstage renal disease was reported in some other studies [32,33]. In accordance with the current results, Pristiner et al described LN patients as having an increased frequency of central nervous system involvement, anemia, thrombocytopenia, and low complement levels [34].…”

Section: Discussion ___________________________supporting

confidence: 92%

Clinical picture of lupus nephritis in patients with systemic lupus erythematosus (SLE): Results of a large survey

et al. 2017

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Systemic lupus erythematosus (SLE) is a chronic multisystem disorder. Lupus nephritis (LN) is a common serious complication of SLE. LN needs prolonged care and complex therapeutic modalities. This study assessed the characteristics of Persian SLE patients with LN (LN subgroup) and an SLE subpopulation without LN (non-LN subgroup). Furthermore, the association of LN with extrarenal manifestations of SLE was studied. This study assessed 2355 SLE patients from the electronic database of the Rheumatology Research Center (RRC), Tehran University of Medical Sciences (TUMS). The clinical and laboratory data of enrolled patients was retrieved. The chi-square test was used to compare extrarenal manifestations of the LN and non-LN subgroups. Odds ratios (OR) were used to present the strength of associations. The LN subgroup included 1604 cases (68.1%) with a mean age at SLE onset of 24.612.5 years and a female-to-male ratio of 8.7/1. Class IV nephritis was the most common type of LN (53.1%). The comparison of extrarenal manifestations revealed statistically significant differences between LN and non-LN subgroups. Major organ involvement including cardiopulmonary, hematologic, musculoskeletal and neuropsychiatric features was significantly more common in LN patients. On the contrary, discoid rash was significantly more common in the non-LN subgroup. This study revealed that LN is positively associated with musculoskeletal, mucocutaneous, and neuropsychiatric features of SLE.

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Section: Discussion ___________________________supporting

confidence: 92%

Clinical picture of lupus nephritis in patients with systemic lupus erythematosus (SLE): Results of a large survey

et al. 2017

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“…A recent study of 554 patients with autosomal dominant polycystic kidney disease did not find, however, that cigarette smoking influences the disease course (39). Concerning systemic diseases with renal involvement, only two studies with contradictory results in patients with lupus nephritis are available (40,41).…”

Section: Patients With Primary Hypertension or Primary Renal Diseasementioning

confidence: 99%

Smoking

Orth

Hallan²

2008

Clinical Journal of the American Society of Nephrology

245

174

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Although it is beyond any doubt that smoking is the number one preventable cause of death in most countries, smoking as an independent progression factor in renal disease has been questioned against the background of evidence-based criteria. This is because information from large, randomized, prospective studies that investigate the effects of smoking on renal function in healthy individuals as well as in patients with primary or secondary renal disease are lacking. Since 2003, a substantial number of clinical and experimental data concerning the adverse renal effects of smoking have been published, including large, prospective, population-based, observational studies. These more recent data together with evidence from experimental studies clearly indicate that smoking is a relevant risk factor, conferring a substantial increase in risk for renal function deterioration. This review summarizes the present knowledge about the renal risks of smoking as well as the increased cardiovascular risk caused by smoking in patients with chronic kidney disease. The conclusion is that smoking is an important renal risk factor, and nephrologists have to invest more efforts to motivate patients to stop smoking.

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“…1,2 The prevalence of SLE and LN and treatment response vary by age, gender, location, and race/ethnicity; LN is especially common in black and Hispanic patients in the United States. 3,4 Use of intravenous cyclophosphamide (IVC) is based on studies in the 1970s and 1980s at the National Institutes of Health (NIH).…”

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confidence: 99%

Mycophenolate Mofetil versus Cyclophosphamide for Induction Treatment of Lupus Nephritis

Appel¹,

Contreras²,

Dooley³

et al. 2009

Journal of the American Society of Nephrology

931

761

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Recent studies have suggested that mycophenolate mofetil (MMF) may offer advantages over intravenous cyclophosphamide (IVC) for the treatment of lupus nephritis, but these therapies have not been compared in an international randomized, controlled trial. Here, we report the comparison of MMF and IVC as induction treatment for active lupus nephritis in a multinational, two-phase (induction and maintenance) study. We randomly assigned 370 patients with classes III through V lupus nephritis to open-label MMF (target dosage 3 g/d) or IVC (0.5 to 1.0 g/m 2 in monthly pulses) in a 24-wk induction study. Both groups received prednisone, tapered from a maximum starting dosage of 60 mg/d. The primary end point was a prespecified decrease in urine protein/creatinine ratio and stabilization or improvement in serum creatinine. Secondary end points included complete renal remission, systemic disease activity and damage, and safety. Overall, we did not detect a significantly different response rate between the two groups: 104 (56.2%) of 185 patients responded to MMF compared with 98 (53.0%) of 185 to IVC. Secondary end points were also similar between treatment groups. There were nine deaths in the MMF group and five in the IVC group. We did not detect significant differences between the MMF and IVC groups with regard to rates of adverse events, serious adverse events, or infections. Although most patients in both treatment groups experienced clinical improvement, the study did not meet its primary objective of showing that MMF was superior to IVC as induction treatment for lupus nephritis.

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Cardiovascular risk factors and the long-term outcome of lupus nephritis

Cited by 78 publications

References 37 publications

Clinical picture of lupus nephritis in patients with systemic lupus erythematosus (SLE): Results of a large survey

Clinical picture of lupus nephritis in patients with systemic lupus erythematosus (SLE): Results of a large survey

Smoking

Mycophenolate Mofetil versus Cyclophosphamide for Induction Treatment of Lupus Nephritis

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