Lupus Nephritis

Kalloo, Sean; Aggarwal, Nidhi; Mohan, Prince

doi:10.2215/cjn.05870612

Cited by 24 publications

(18 citation statements)

References 72 publications

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“…Furthermore, systemic lupus erythematosus is a complex autoimmune disorder which has heterogeneous disease course and clinical manifestations. Its distinctive features are its dysregulated adaptive immune pathways and progression of anti-nuclear antibodies (13). Lupus nephritis is a severe manifestation of SLE which has a complex pathogenesis.…”

Section: Discussionmentioning

confidence: 99%

“…Products of the adaptive immune response might serve as predictors for disease activity and through blocking activation of specific components of the adaptive immune, there may be therapeutic effects in controlling inflammation (7). The current treatment approach includes steroidal and non-steroidal anti-inflammatory agents and immunosuppressive drugs, antimalarial medication, as well as azathioprine, cyclophosphamide, methotrexate and mycophenolic (MMF) acid (13). Although there has been considerably advanced improvement in prognosis for SLE patients, overcoming the difficulties in treating patients with active disease refractory to traditional therapies continues to be a challenge.…”

Section: Discussionmentioning

confidence: 99%

“…Although there has been considerably advanced improvement in prognosis for SLE patients, overcoming the difficulties in treating patients with active disease refractory to traditional therapies continues to be a challenge. Not too far into the future are, new targeted therapies specially designed to block pathways involved in disease pathogenesis (13). As knowledge of the initiation and progression of the disease grows, we can look forward to therapeutic possibilities that focus on blocking defined phases of disease pathogenesis (13).…”

Section: Discussionmentioning

confidence: 99%

“…Not too far into the future are, new targeted therapies specially designed to block pathways involved in disease pathogenesis (13). As knowledge of the initiation and progression of the disease grows, we can look forward to therapeutic possibilities that focus on blocking defined phases of disease pathogenesis (13). A large number of patients do not attain remission using regular procedures combining cyclophosphamide or MMF.…”

Section: Discussionmentioning

confidence: 99%

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Coexistence of lupus nephritis and sickle cell trait, an electron microscopic assessment of renal glomerular damage: Case report of a rare association

Elficki¹,

Rawas²,

Bossei³

et al. 2017

Electron Physician

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Because of similarities of the musculoskeletal, central nervous system, and renal manifestations in both diseases, diagnosing systemic lupus erythematosus (SLE) in sickle cell disease (SCD) patients can be difficult to establish. Although Sickle Cell Trait (SCT) is still considered a benign form of SCD, its impact on kidney injury and other renal manifestations is well recognized in the literature. In this case report, we look at the challenges that develop when diagnosing patients with a concurrence of both diseases and the importance of early recognition and treatment of lupus nephritis in SCT patients. We present a case of a male patient with sickle-cell trait who was admitted to our hospital complaining of low grade fever and pancytopenia for investigations proven to be SLE. A renal biopsy on electron microscopy assessment with different staining modalities as well as immune fluorescence revealed mixed pathological changes. We emphasize the importance in considering the presence of a coexisting autoimmune disease in a patient with sickle hemoglobinopathies even in the milder forms like SCT which may display an atypical and/or multisystem presentation. Also, the impact of the two conditions on the renal pathological changes should be expected to be more damaging even at early onset of SLE flare, and hence, an urge to start with more intensified immunosuppressive medications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Coexistence of lupus nephritis and sickle cell trait, an electron microscopic assessment of renal glomerular damage: Case report of a rare association

Elficki¹,

Rawas²,

Bossei³

et al. 2017

Electron Physician

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“…Several reasons have been posited for failure to respond, including ethnicity and underlying disease. Therefore, alternative strategies for the management of refractory or severe relapsing LN are necessary [1,2]. …”

Section: Introductionmentioning

confidence: 99%

Mycophenolate in Refractory and Relapsing Lupus Nephritis

Rivera

Mérida²,

Illescas³

et al. 2014

Am J Nephrol

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Background: Mycophenolate (MF) is effective as induction and maintenance treatment in patients with lupus nephritis (LN). This study evaluates the efficacy and safety of MF in patients with refractory and relapsing LN. Methods: Data were retrospectively obtained for 85 patients (35 refractory and 50 relapsing) from 11 nephrology departments in Spain. The primary endpoints were the incidence and cumulative number of renal responses and relapses and their relationship with baseline clinical and analytical data. The secondary endpoint was the appearance of side effects. Results: The main clinical and analytical variables were similar both in refractory and relapsing LN. Most of the patients had received cyclophosphamide, and all of them switched to MF. 74 patients (87%) achieved a response (69% partial, 31% complete). Age at starting MF, gender, pathological classification, body mass index, blood pressure, baseline renal function, and proteinuria were not associated with achieving response. After stopping MF, 3 of 19 patients (15.7%) relapsed, all at 6 months of follow-up. No differences were found between clinical and analytical variables and number of relapses. Side effects were unremarkable, except for 1 patient, who died of thrombocytopenia and ovarian hemorrhage. Conclusions: Switching to MF from other immunosuppressive treatments is effective and safe in refractory and relapsing LN.

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Bcl‐2 Antagonists Kill Plasmacytoid Dendritic Cells From Lupus‐Prone Mice and Dampen Interferon‐α Production

Zhan

Carrington

et al. 2015

Arthritis & Rheumatology

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Objective. Interferon-␣ (IFN␣)-producing plasmacytoid dendritic cells (PDCs) are implicated in the pathogenesis of systemic lupus erythematosus (SLE). IFN␣-related genes are highlighted among SLE susceptibility alleles and are characteristically expressed in the blood of patients with SLE, while in mouse models of lupus, PDC numbers and IFN␣ production are increased. This study was undertaken to investigate the effects of inhibitors that selectively target different antiapoptotic molecules on the survival of PDCs.Methods. PDC numbers, in vitro survival, and expression of antiapoptotic molecules were evaluated in lupus-prone (NZB ؋ NZW)F1 (NZB/NZW) mice. The impact of Bcl-2 antagonists and glucocorticoids on PDCs was evaluated in vitro and in vivo. IFN␣ production by NZB/NZW mice was evaluated before and after treatment with Bcl-2 antagonists.Results. PDCs, but not lymphoid tissue-resident conventional DCs, largely relied on the antiapoptotic protein Bcl-2 for survival. The enlarged PDC compartment in NZB/NZW mice was associated with selectively prolonged survival and increased Bcl-2 transcription. Functionally, this resulted in enhanced production of IFN␣. Bcl-2 inhibitors selectively killed mouse and human PDCs, including PDCs from SLE patients, but not conventional DCs, dampened IFN␣ production by PDCs, and synergized with glucocorticoids to kill activated PDCs.Conclusion. Enhanced PDC survival is a likely contributing factor to enhanced IFN␣ production by lupus PDCs. Bcl-2 antagonists potently and selectively kill PDCs and reduce IFN␣ production. Thus, we believe that they are attractive candidates for treating PDCassociated diseases.

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Lupus Nephritis

Cited by 24 publications

References 72 publications

Coexistence of lupus nephritis and sickle cell trait, an electron microscopic assessment of renal glomerular damage: Case report of a rare association

Coexistence of lupus nephritis and sickle cell trait, an electron microscopic assessment of renal glomerular damage: Case report of a rare association

Mycophenolate in Refractory and Relapsing Lupus Nephritis

Bcl‐2 Antagonists Kill Plasmacytoid Dendritic Cells From Lupus‐Prone Mice and Dampen Interferon‐α Production

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