Systemic Lupus Erythematosus After Renal Transplantation: Is Complement a Good Marker for Graft Survival?

Baracat, Andre Luis Signori; Ribeiro-Alves, Maria Almerinda; Alves-Filho, G.; Mazzali, Marilda

doi:10.1016/j.transproceed.2008.02.045

Cited by 16 publications

(2 citation statements)

References 9 publications

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“…Comparative studies131 132 and cases series133 134 support that patients with SLE are good candidates for renal transplantation performed when clinical (and ideally, serological) lupus activity is absent, or at a low level, for at least 3–6 months135; best results are obtained with living donor136–138 and pre-emptive transplantation 139. Patients with moderate to high titres of anti-phospholipid antibodies are at increased risk for thrombotic complications and may receive anticoagulants perioperatively 140–143.…”

Section: Resultsmentioning

confidence: 99%

Joint European League Against Rheumatism and European Renal Association–European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis

et al. 2012

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ObjectivesTo develop recommendations for the management of adult and paediatric lupus nephritis (LN).MethodsThe available evidence was systematically reviewed using the PubMed database. A modified Delphi method was used to compile questions, elicit expert opinions and reach consensus.ResultsImmunosuppressive treatment should be guided by renal biopsy, and aiming for complete renal response (proteinuria <0.5 g/24 h with normal or near-normal renal function). Hydroxychloroquine is recommended for all patients with LN. Because of a more favourable efficacy/toxicity ratio, as initial treatment for patients with class III–IVA or A/C (±V) LN according to the International Society of Nephrology/Renal Pathology Society 2003 classification, mycophenolic acid (MPA) or low-dose intravenous cyclophosphamide (CY) in combination with glucocorticoids is recommended. In patients with adverse clinical or histological features, CY can be prescribed at higher doses, while azathioprine is an alternative for milder cases. For pure class V LN with nephrotic-range proteinuria, MPA in combination with oral glucocorticoids is recommended as initial treatment. In patients improving after initial treatment, subsequent immunosuppression with MPA or azathioprine is recommended for at least 3 years; in such cases, initial treatment with MPA should be followed by MPA. For MPA or CY failures, switching to the other agent, or to rituximab, is the suggested course of action. In anticipation of pregnancy, patients should be switched to appropriate medications without reducing the intensity of treatment. There is no evidence to suggest that management of LN should differ in children versus adults.ConclusionsRecommendations for the management of LN were developed using an evidence-based approach followed by expert consensus.

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Section: Resultsmentioning

confidence: 99%

Joint European League Against Rheumatism and European Renal Association–European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis

et al. 2012

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“…The discordant histological findings seen in the present case may be the result of overlapping chronic endothelial injury manifesting as transplant glomerulopathy and mesangial deposition of immune complex associated with RLN. Post‐transplant proteinuria with low complement level in SLE recipients was reportedly a risk factor for recurrence of immune deposits (10). The relative paucity of immune deposit and non‐specific findings of IF in this case may be a result of prolonged immunosuppressive therapy (11).…”

Section: Discussionmentioning

confidence: 99%

Overlapped glomerular lesions of chronic rejection and recurrent lupus nephritis in transplanted kidney: a case report

Masuzawa

Urasaki

Okamoto³

et al. 2011

Clinical Transplantation

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Masuzawa N, Urasaki K, Okamoto M, Nobori S, Ushigome H, Yoshimura N, Yanagisawa A. Overlapped glomerular lesions of chronic rejection and recurrent lupus nephritis in transplanted kidney: a case report. Clin Transplant 2011: 25 (Suppl. 23): 49–52. © 2011 John Wiley & Sons A/S. Abstract: We describe a renal transplant recipient with systemic lupus erythematosus (SLE) who showed continuous proteinuria and low complement levels without clinical evidence of active SLE. Her first renal allograft biopsy, performed nine yr and eight months after transplantation, revealed unusual histological change of glomeruli, and it initially led us to make a contradictory diagnosis based on light and electron microscopic examinations. Diffuse global double‐ or multi‐contour glomerular basement membrane was caused by chronic endothelial injury owing to chronic rejection, and mesangial proliferation associated with mesangial electron‐dense deposit was a histological change characteristic of recurrent lupus nephritis (RLN). Immunofluorescence study displayed weak mesangial staining of IgM and C1q. We concluded that this case presented overlapped chronic rejection and RLN. Because both transplant nephropathy and lupus nephritis present constellations of various histologies, it is difficult to diagnose their overlap. Complete morphologic studies with both immunofluorescence and electron microscopic evaluations in addition to microscopic examination should be performed to elucidate complex histological findings.

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Early outcomes in kidney transplant recipients with systemic lupus erythematosus

et al. 2019

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Systemic Lupus Erythematosus After Renal Transplantation: Is Complement a Good Marker for Graft Survival?

Cited by 16 publications

References 9 publications

Joint European League Against Rheumatism and European Renal Association–European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis

Joint European League Against Rheumatism and European Renal Association–European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis

Overlapped glomerular lesions of chronic rejection and recurrent lupus nephritis in transplanted kidney: a case report

Early outcomes in kidney transplant recipients with systemic lupus erythematosus

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