Immunosuppressive therapy of lupus nephritis

Department of Medicine, University of North Carolina at Chapel Hill, North Carolina, United States
Lupus (Impact Factor: 2.48). 02/1998; 7(9):630-4. DOI: 10.1191/096120398678920767
Source: PubMed

ABSTRACT Aggressive immunosuppressive therapy should be considered for patients with proliferative lupus nephritis as the risk for progression to end stage renal disease is high. Intermittent intravenous cyclophosphamide therapy improves renal survival; longer duration of therapy is associated with fewer relapse of nephritis and decreased risk of diminished renal function. While azathioprine therapy does not differ statistically from steroids alone in prolonging renal survival, this therapy may be considered in patients with few risk factors for progression to renal insufficiency. Methylprednisolone as a single therapy does not prolong renal survival compared with regimens including cyclophosphamide. Plasmapheresis remains under study but has not shown additional benefit in treatment of severe lupus nephritis. The potential roles for cyclosporin A and mycophenylate mofetil in the therapy of proliferative lupus nephritis remain to be defined. Supportive care including rigorous control of hypertension, consideration of angiotensin receptor inhibition or blockade to reduce proteinuria and prolong renal function, control of hyperlipidemia, prevention of osteoporosis, and prevention of pregnancy remain important clinical goals. Current research efforts focus on genetic and socioeconomic factors involved in racial differences in expression of lupus nephritis, hormonal manipulation to preserve gonadal function during cyclophosphamide therapy, and the potential impact on lupus activity of estrogen-containing oral contraceptives or postmenopausal hormone replacement therapy.

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    ABSTRACT: SUMMARY The aim of study is to investigate influence of tamsulosin on detrusor in patients with BPH. This is multi-centre, prospective and open study. Our analysis covers 20 patients above 45 y, with IPSS≥8, RU<100 ml, PSA<4 ng/ml and last 3 months no LUTS treatment. At the end of screening with inclusion criteria, patients were treated with tamsulosin 0.4 mg o.d. for 3 month. We measured parameters for evaluation after 4 and 12 weeks of active treatment period: a. Primary: ultrasound estimated bladder weight /UEWB/ according to the techniques already described by Kojima et al. B&K Medical and Digital Communications developed software for linking the data obtained by measuring the bladder wall thickness with PC for calculating the UEWB. The bladder wall thickness was measured by using a linear probe 6-10 MHz by scans of the anterior wall at three points with a distance of about 1 cm between them; b. Secondary: pulse and blood pressure, T-IPSS, I-IPSS, O-IPSS, quality of life, US-residual urine, prostate volume and side effects of tamsulosin treatment. At screening, average value of UEWB was 64 gr., RU 47 ml, T-IPSS 15.4 points, I-IPSS 7.1 points, O-IPSS 8.4, IPSS Q&L 3.6. After 4 and 12 weeks of active treatment period we measured average value of UEWB 40 and 37gr., RU 30 and 23 ml, T-IPSS 7.4 and 5.2, I-IPSS 3.5 and 2.8, O-IPSS 3.9 and 2.5, IPSS Q&L 1.5 and 0.9. Side effects of tamsulosin treatment (ejaculation and libido problems 5%, headache 10%) were infrequent and mild and not a single patient stopped the treatment. Statistical analysis used comparison between results at the screening, 4 and 12 active treatment period with paired samples t test. We concluded that during 12-week tamsulosin treatment, all components of LUTS, measured with IPSS, improved significantly and residual urine decreased. With increased time of treatment, effect of tamsulosin statistically increased. Treatment did not influence pulse rate or blood pressure. After 12 weeks of treatment we measured significant reduction of ultrasound estimated bladder weight. Key words: urinary bladder, benign prostate hyperplasia, tamsulosin, bladder wall thickness, ultrasound estimated bladder weight
    Acta Informatica Medica 01/2008; 16(4):210-14.
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    ABSTRACT: Serial sample labeling • Management of quantitative information • Samples handling by robot • Processing measurement data • Reporting (delivering findings) • Planning of laboratory resources • Quality monitoring • Communication with other informa-tion systems Integrated process like this assures the laboratory information management system (LIMS), which connects the in-struments, resources and personnel in a wide unique network within the most important link, is a link computer -auto analyzer. During this is necessary to use the central laboratory computer, which works with multiple terminals in real time and on which micro computers can be linked as peripheral computers. The purpose of laboratory automation is to increase pro-ductivity, which is specifically defined as the collection and reporting the results of tests in a period of time in order to achieve maximum accuracy and precision of mea-surements without the expansion of re-sources and increase of labor costs. The main reasons for the introduction of LIMS are: • Increased number of findings requests • Increased number of complex analyses • Increased number of unnecessary analyses • Emergency of demands • Loss of professional staff time on ad-ministrative jobs Inability to work more seriously on professional and scientific analysis of test and experiments results. The number of completed clinical-lab-oratory analyses in the developed coun-tries shows a high rate of growth which annually ranges from 10-17%, showing increase in the number of tested persons and the number of analysis by a patient. This phenomenon is a result of the prog-ress of medical science but also the tech-nological revolution in the field of labo-ratory equipment and biochemistry im-mune diagnostics. Serial labeling of samples is done im-191-196 SUMMARY Introducrion: Computers and information technology significantly improve the work in various laboratories (clinical-biochemistry, hematology, immunology, cytology, etc) since it automates the testing and speeds up delivery of findings. The number of completed clinical-laboratory analysis in the developed countries shows high rate of growth that annually ranges from 10-17. Systemic lupus erythematosus is the disorder of immune regulation which is mani-fested by activation of T and B lymphocytes, production of antibodies, and the formation of immune complex causing damage to tissues. SLE is a disease that progresses over time and has been intriguing to the doctors for more than a century while holding being a prototype of autoimmune disease. Kidney function loss is the most serious complication of SLE which represents a threat for long-term survival. Goal: The aim is to show the clinical and labora-tory parameters of lupus nephritis and principle of therapeutic protocol for the treatment of lupus nephritis using aggressive immunosuppressive therapy at the Institute of Nephrology of Clinical Center of the Sarajevo University by monitoring activity of disease. Patients and methods: Randomized retrospective study includes 14 patients with SLE and lupus nephritis that are treated at the Institute of Nephrology of Clinical Center University of Sarajevo in the period from the beginning of 2000 to 2003. Discussion: In our retrospective study, all patients were females with mean age of 34.5±13.5 years. Mean age at the beginning of SLE was 30.5±12.5 years. Most often clinical manifestations observed in patients with SLE are general ones (85.7%) -skeletal muscle (64.3%), skin (78.6%), hematologic (64.3), cardiac and pulmonal (42.9), neurologic (21.4%), thrombosis (35.7%), eye (14.3%) and abortion (7%). Conclusion: Females in reproductive age have SLE and lupus nephritis more frequently , which indicates that hormonal status (estrogen) has important role in illness pathogenesis. Most relevant parameters in evaluation of illness activity are the levels of complement components C3 and C4, level of antidsDNA, activity of urine sediment and proteinuria level. Aggressive immunosuppressive therapy that includes corticosteroids and cyclophosphamide, with control of side effects and its prevention, and duly treatment can lead to improvement of clinical symptoms and improvement of patient life. As long as new therapeutic modalities and more efficient treatment of autoimmune illnesses is not available, the greatest impact on mortality and morbidity can be achieved by monitoring late manifestations and treatment of extracranial manifestations that can lead to kidney function loss.
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    ABSTRACT: Purpose. – Renal involvement is one of the most severe and frequent manifestations of systemic lupus erythematosus. Prognosis factors are variable in the different studies. We analyze in 211 patients clinical, biological and histologic characteristics of lupus nephritis and the different prognosis factors.Methods. – It's a retrospective study in 211 with lupus nephritis followed-up between 1975 and 2003.Results. – There were 195 women and 16 men aged meanly of 28,8 years. At first presentation, we noted hypertension in 32,3% of cases, nephrotic syndrome in 47,7% of cases and renal failure in 51,6% of cases. histologic examination of kidney revealed class III in 59 cases, class IV in 97 cases and class V in 33 cases. Two hundred and five patients were treated by corticosteriods associated with immunosupressive agents in 95 cases. After a mean follow-up of 103 months (2–289 months), we obtained remission in 55,3% deterioration of renal function in 34,8% with end stage renal failure in 14,7% and relapses occurred in 51% of cases. Thirty-three patients died. Age
    La Revue de Médecine Interne 01/2005; 26(1):8-12. DOI:10.1016/j.revmed.2004.09.003 · 1.32 Impact Factor