Prognostic Value of Renal Hemodynamic Characteristics in Patients with Proliferative Lupus Nephritis

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background/Aim: Previous studies showed that renal hemodynamic parameters, especially the filtration fraction (FF), are decreased in patients with active lupus nephritis (LN). In this study, we evaluate the prognostic value of renal hemodynamic function tests on the renal outcome in patients with proliferative LN. Methods: We performed a retrospective cohort study of our patients with proliferative LN from 1986 to 2005. Glomerular filtration rate (GFR) and FF before treatment were measured. Treatment failure was defined as a renal relapse or development of end-stage renal disease. Results: Thirty-seven patients were included. The median follow-up period was 8 years. Creatinine clearance, GFR, and FF before treatment correlated with the creatinine clearance at the end of follow-up (p = 0.001, p = 0.006, and p = 0.04, respectively). The FF was decreased in 92% of our patients, but FF and GFR did not have a prognostic value with regard to treatment failure. Conclusions: Most patients with proliferative LN had a low FF. Low GFR and FF at baseline were correlated with a worse renal function at the end of follow-up, but this had no prognostic value in individual patients.

Related collections

Most cited references 11

Record: found
Abstract: found
Article: not found

Limitations of creatinine as a filtration marker in glomerulopathic patients.

Ovadia Shemesh, Helen Golbetz, Joseph P. Kriss … (1985)

To determine the reliability of creatinine as a measure of the glomerular filtration rate (GFR), we compared the simultaneous clearance of creatinine to that of three true filtration markers of graded size in 171 patients with various glomerular diseases. Using inulin (radius [rs] = 15 A) as a reference marker, we found that the fractional clearance of 99mTc-DTPA (rs = 4 A) was 1.02 +/- 0.14, while that of a 19 A rs dextran was 0.98 +/- 0.13, with neither value differing from unity. In contrast, the fractional clearance (relative to inulin) of creatinine (rs = 3 A) exceeded unity, averaging 1.64 +/- 0.05 (P less than 0.001), but could be lowered towards unity by acute blockade of tubular creatinine secretion by IV cimetidine. Cross-sectional analysis of all 171 patients revealed fractional creatinine secretion to vary inversely with GFR. This inverse relationship was confirmed also among individual patients with either deteriorating (N = 28) or remitting (N = 26) glomerular disease, who were studied longitudinally. As a result, changes in creatinine relative to inulin clearance were blunted considerably or even imperceptible. We conclude that true filtration markers with rs less than 20 A, including inulin, are unrestricted in glomerular disease, and that creatinine is hypersecreted progressively by remnant renal tubules as the disease worsens. Accordingly, attempts to use creatinine as a marker with which to evaluate or monitor glomerulopathic patients will result in gross and unpredictable overestimates of the GFR.

0 comments Cited 154 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Therapy of lupus nephritis. Controlled trial of prednisone and cytotoxic drugs.

MARVIN STEINBERG, J Klippel, Robert Austin … (1986)

We evaluated renal function in 107 patients with active lupus nephritis who participated in long-term randomized therapeutic trials (median follow-up, seven years). For patients taking oral prednisone alone, the probability of renal failure began to increase substantially after five years of observation. Renal function was better preserved in patients who received various cytotoxic-drug therapies, but the difference was statistically significant only for intravenous cyclophosphamide plus low-dose prednisone as compared with high-dose prednisone alone (P = 0.027). The advantage of treatment with intravenous cyclophosphamide over oral prednisone alone was particularly apparent in the high-risk subgroup of patients who had chronic histologic changes on renal biopsy at study entry. Patients treated with intravenous cyclophosphamide have not experienced hemorrhagic cystitis, cancer, or a disproportionate number of major infections. We conclude that, as compared with high-dose oral prednisone alone, treatment of lupus glomerulonephritis with intravenous cyclophosphamide reduces the risk of end-stage renal failure with few serious complications.

0 comments Cited 130 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Early response to immunosuppressive therapy predicts good renal outcome in lupus nephritis: lessons from long-term followup of patients in the Euro-Lupus Nephritis Trial.

Enrique de Ramon Garrido Ed, Carlos AC Vasconcelos, Mauro Galeazzi … (2004)

In the Euro-Lupus Nephritis Trial (ELNT), 90 patients with lupus nephritis were randomly assigned to a high-dose intravenous cyclophosphamide (IV CYC) regimen (6 monthly pulses and 2 quarterly pulses with escalating doses) or a low-dose IV CYC regimen (6 pulses of 500 mg given at intervals of 2 weeks), each of which was followed by azathioprine (AZA). After a median followup of 41 months, a difference in efficacy between the 2 regimens was not observed. The present analysis was undertaken to extend the followup and to identify prognostic factors. Renal function was prospectively assessed quarterly in all 90 patients except 5 who were lost to followup. Survival curves were derived using the Kaplan-Meier method. After a median followup of 73 months, there was no significant difference in the cumulative probability of end-stage renal disease or doubling of the serum creatinine level in patients who received the low-dose IV CYC regimen versus those who received the high-dose regimen. At long-term followup, 18 patients (8 receiving low-dose and 10 receiving high-dose treatment) had developed permanent renal impairment and were classified as having poor long-term renal outcome. We demonstrated by multivariate analysis that early response to therapy at 6 months (defined as a decrease in serum creatinine level and proteinuria <1 g/24 hours) was the best predictor of good long-term renal outcome. Long-term followup of patients from the ELNT confirms that, in lupus nephritis, a remission-inducing regimen of low-dose IV CYC followed by AZA achieves clinical results comparable with those obtained with a high-dose regimen. Early response to therapy is predictive of good long-term renal outcome.

0 comments Cited 72 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (publisher-id): KBR

Journal ID (nlm-ta): Kidney Blood Press Res

Journal ID (doi): 10.1159/issn.1420-4096

Title: Kidney and Blood Pressure Research

Publisher: S. Karger AG

ISSN (Print): 1420-4096

ISSN (Electronic): 1423-0143

Publication date Subscription-year: 2007

Publication date (Print): June 2007

Publication date (Electronic): 22 May 2007

Volume: 30

Issue: 3

Pages: 175-181

Affiliations

Department of Rheumatology and Clinical Immunology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands

Article

Publisher ID: 102986 Other ID: Kidney Blood Press Res 2007;30:175–181

DOI: 10.1159/000102986

PubMed ID: 17519528

SO-VID: 9dae3699-1517-474e-b0ec-4007ce53c4a8

License:

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

History

Date received : 21 December 2006

Date accepted : 05 March 2007

Page count

Figures: 2, Tables: 3, References: 18, Pages: 7

Call for Papers: Green Renal Replacement Therapy: Caring for the Environment

Submit here before July 31, 2024

Prognostic Value of Renal Hemodynamic Characteristics in Patients with Proliferative Lupus Nephritis

Read this article at

Abstract

Related collections

Karger: Nephrology

Most cited references 11

Limitations of creatinine as a filtration marker in glomerulopathic patients.

Therapy of lupus nephritis. Controlled trial of prednisone and cytotoxic drugs.

Early response to immunosuppressive therapy predicts good renal outcome in lupus nephritis: lessons from long-term followup of patients in the Euro-Lupus Nephritis Trial.

Author and article information

Journal

Affiliations

Article

History

Page count

Categories

Comments

Comment on this article

Similar content 186

Most referenced authors 363