Recent advances in the treatment of lupus nephritis

Uchida, Keiko; Nitta, Kosaku

doi:10.1007/s10157-011-0556-4

Cited by 10 publications

(9 citation statements)

References 65 publications

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“…The results of this study indicate that SLE patients who underwent renal biopsy of being able to reduce the PSL dose [10]. Thus, our therapeutic strategy differs considerably from that recommended in the LN Treatment Guidelines published by the American College of Rheumatology (ACR) in 2012 [15].…”

Section: Discussioncontrasting

confidence: 40%

“…In America and Europe, the ten years renal survival rate has improved to 80% -90% with the implementation of current immunosuppressive regimens [8]. Although the survival prognosis of patients with SLE has improved over the past three decades, the prognosis in terms of the renal outcome has not kept pace [9] [10]. The present study was designed as a retrospective observational cohort study of patients with LN who have undergone renal biopsy, to identify the factors affecting the long-term renal outcome in patients with LN.…”

mentioning

confidence: 99%

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Long-Term Outcome of 102 Cases of Lupus Nephritis: A Single-Center Cohort Study in Japan

Kodama¹,

Uchida²,

Karasawa³

et al. 2017

IJCM

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Background: The mortality rate is higher in SLE patients with lupus nephritis (LN) than in those without nephropathy. Objectives: The aim of this study was to identify the factors affecting the long-term renal outcome in 102 patients with LN. Methods: This was a retrospective cohort study. Logistic regression analysis was used in a model to determine how independent variables predicted the outcome. The survival analysis was based on the Kaplan-Meier curve with subjects censored for death. Results: The 15-year survival rate was 93.5%, and the renal function non-deterioration rate was 78.3%. No influence of individual types of immunosuppressant drugs used was found on the renal function deterioration rate. In this study, the results of analysis identified only daily urinary protein excretion level as having any significant effect on the risk of progression of LN to renal failure. Conclusions: These results suggest that remission induction therapy and maintenance therapy focused on long-term preservation of renal function need to be selected for LN patients with a high daily urinary protein value at the start of treatment and for LN patients who fail to show any reduction of the daily urinary protein excretion level to 0.5 g or less at one year after the biopsy.

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Section: Discussioncontrasting

confidence: 40%

mentioning

confidence: 99%

Long-Term Outcome of 102 Cases of Lupus Nephritis: A Single-Center Cohort Study in Japan

Kodama¹,

Uchida²,

Karasawa³

et al. 2017

IJCM

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“…LN impacts the clinical outcome of SLE both directly, in the form of target organ damage, and indirectly, through adverse effects of therapy [ 178 ]. On the other hand, the histological patterns of LN provide the basis for therapeutic guidelines and decisions to prevent target organ damage, as they are predictive.…”

Section: Recent Advances In Ln Therapymentioning

confidence: 99%

Lupus Nephritis: An Overview of Recent Findings

Salgado

Herrera-Diaz

2012

Autoimmune Diseases

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Lupus nephritis (LN) is one of the most serious complications of systemic lupus erythematosus (SLE) since it is the major predictor of poor prognosis. In susceptible individuals suffering of SLE, in situ formation and deposit of immune complexes (ICs) from apoptotic bodies occur in the kidneys as a result of an amplified epitope immunological response. IC glomerular deposits generate release of proinflammatory cytokines and cell adhesion molecules causing inflammation. This leads to monocytes and polymorphonuclear cells chemotaxis. Subsequent release of proteases generates endothelial injury and mesangial proliferation. Presence of ICs promotes adaptive immune response and causes dendritic cells to release type I interferon. This induces maturation and activation of infiltrating T cells, and amplification of Th2, Th1 and Th17 lymphocytes. Each of them, amplify B cells and activates macrophages to release more proinflammatory molecules, generating effector cells that cannot be modulated promoting kidney epithelial proliferation and fibrosis. Herein immunopathological findings of LN are reviewed.

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“…In fact literature advises that all patients with proteinuria of more than or equal to 0.5 g in 24 h should receive renin-angiotensin system blockade [27]. ACE inhibitor therapy and ARB not only help maintain blood pressure lower than 130/80 mmHg, but also reduce proteinuria and may even prevent the development of biopsy-proven glomerulonephritis [28,29].…”

Section: Discussionmentioning

confidence: 99%

Hypertensive Emergency in Adolescent with Systemic Lupus Erythematosus at Onset: A Case Report

Cucuzza¹,

Garozzo²,

Attardo³

et al. 2016

Immunol Disord Immunother

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The severity of Systemic lupus erythematosus (SLE) at onset represents the most important biomarker of disease outcome and of treatment response in paediatric patients. Kidney disease, chronic systemic inflammation and steroid toxicity could cause hypertension development. Thirteen year old child presenting with serositis, hemolytic anemia, leucopenia, thrombocytopenia and lupus nephritis was treated according to Euro Lupus Protocol. A progressive deterioration of kidney function was observed during the treatment with increased blood pressure for about a month after the beginning of the treatment. The antihypertensive therapy established by the Italian society of pediatrics (SIP) and consisting of diuretic therapy (Furosemide 1 mg/Kg/die) and angiotensin-converting-enzyme (ACE) inhibitor therapy (Enalapril 0.06 mg/Kg/die) was initiated. Persisting hypertensive peaks, calcium antagonist therapy (Amlodipina 5 mg/die) and α2 adrenergic therapy (Clonidina one plaster/2.5 mg/week) were added. After gaining control of the hypertensive peaks, the antihypertensive treatment was gradually reduced. There are no treatment protocols for the management of hypertension associated with SLE in children in the literature. In our case the early treatment with the SIP protocol determined reduction in urinary protein levels and avoided acute organ damage related to hypertension peaks.

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Recent advances in the treatment of lupus nephritis

Cited by 10 publications

References 65 publications

Long-Term Outcome of 102 Cases of Lupus Nephritis: A Single-Center Cohort Study in Japan

Long-Term Outcome of 102 Cases of Lupus Nephritis: A Single-Center Cohort Study in Japan

Lupus Nephritis: An Overview of Recent Findings

Hypertensive Emergency in Adolescent with Systemic Lupus Erythematosus at Onset: A Case Report

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