Prednisone monotherapy induced remission in a group of patients with membranous lupus nephritis

Nenhuma Miniatura disponível
Citações na Scopus
5
Tipo de produção
article
Data de publicação
2011
Editora
DUSTRI-VERLAG DR KARL FEISTLE
DOI
Indexadores
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Autores
DIAS, C. Bitencourt
PINHEIRO, C. C.
BRITO, G. Alves de
ABRAO, J. Gera
SILVA, V. dos Santos
Autor de Grupo de pesquisa
Editores
Coordenadores
Organizadores
Citação
CLINICAL NEPHROLOGY, v.76, n.1, p.57-63, 2011
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
The treatment of membranous lupus nephritis (MLN) is still controversial in the literature. We conducted a retrospective analysis of patients in two medical centers of Sao Paulo-Brazil in order to evaluate the clinical response in patients submitted to either a regimen with prednisone alone or to a double immunosuppressive regimen (prednisone plus cyclophosphamide or prednisone plus azathioprine). Methods: MLN female patients were enrolled in this retrospective study conducted from February 1999 to June 2007. Data were collected from the patients' medical charts. Race distribution was similar in both groups: Caucasian (72.3%) and Afro-Latin-American (27.7%). The prednisone regimen consisted of 1 mg/kg/day for 8 weeks and tapering until 0.1 mg/kg/day (n = 29). The double immunosuppressive treatment consisted of the same doses of prednisone plus monthly intravenous cyclophosphamide or azathioprine for 6 months (n = 24). Criteria for remission (complete and partial) and renal function loss as well as flare criteria followed those used in the literature. Results: There was no difference between the prednisone group and the double immunosuppressive group regarding age (33.2 +/- 9.4 vs. 29.1 +/- 9.1 y), estimated GFR (76.5 +/- 26.6 vs. 74.1 +/- 39.6 ml/min/1.73 m(2)), serum albumin (2.8 +/- 0.7 vs. 2.6 +/- 0.3 g/dl), positive ANA (87.5 vs. 90.0%), positive anti-dsDNA (47.6 vs. 44.0%), renal SLEDAI indices (6.6 +/- 2.6 vs. 7.0 +/- 3.1), follow-up time (71 +/- 46 vs. 62 +/- 45 months), as well as proteinuria (3.1 +/- 1.9 vs. 4.8 +/- 2.4 g/day) and number of non-nephrotic patients (6 in the prednisone group vs. 3 in the double immunosuppressive group). The prednisone group presented higher C3 values (85.2 +/- 31.5 vs. 62.3 +/- 41.6 U/ml, p = 0.04). Clinical and laboratory characteristics at 6 months and at last follow-up did not reveal any differences between treatment regimens. Renal survival after an 8-year follow-up did not differ in both groups (prednisone group 86.2% vs. double immunosuppressive group 75%), and patients in both groups showed a high rate of renal flares (prednisone group 51.7% vs. double immunosuppressive group 62.5%). Univariate analysis showed that only patient age predicted flares (r = -0.048, p = 0.04). Borderline significance was obtained for proteinuria analysis (p = 0.07). Adverse effects did not differ between the groups. Conclusions: A regimen of corticosteroids in MLN induced a high remission rate after 6 months. Both treatment regimens showed a high flare rate and age was the only predictive parameter (r = -0.048, p = 0.04). Renal survival after 8 years did not differ between the groups.
Palavras-chave
lupus nephritis, immunosuppressive drugs, membranous nephropathy, proteinuria, epidemiology
URI
https://observatorio.fm.usp.br/handle/OPI/22633
Referências
  1. Weening JJ, 2004, J AM SOC NEPHROL, V15, P241, DOI 10.1097/01.ASN.0000108969.21691.5D
  2. Sun HO, 2008, LUPUS, V17, P56, DOI 10.1177/0961203307083443
  3. Hochberg MC, 1997, ARTHRITIS RHEUM, V40, P1725, DOI 10.1002/art.1780400928
  4. Markowitz GS, 2007, KIDNEY INT, V71, P491, DOI 10.1038/sj.ki.5002118
  5. Austin HA, 2009, J AM SOC NEPHROL, V20, P901, DOI 10.1681/ASN.2008060665
  6. Mok CC, 2004, AM J KIDNEY DIS, V43, P269, DOI 10.1053/j.ajkd.2003.10.029
  7. Mok CC, 2009, NAT REV NEPHROL, V5, P212, DOI 10.1038/nrneph.2009.14
  8. Austin HA, 2005, LUPUS, V14, P65, DOI 10.1191/0961203305lu2062oa
  9. Balow JE, 2003, SEMIN NEPHROL, V23, P386, DOI 10.1016/S0270-9295(03)00056-1
  10. Chan TM, 1999, LUPUS, V8, P545, DOI 10.1191/096120399678840837
  11. Churg J, 1995, RENAL DIS CLASSIFICA
  12. JACOBSON SH, 2006, NEPHROL DIAL TRANSPL, V23, P1
  13. Kapitsinou PP, 2004, RHEUMATOLOGY, V43, P377, DOI 10.1093/rheumatology/keh012
  14. Kitiyakara C, 2008, CLIN NEPHROL, V69, P90
  15. Mercadal L, 2002, NEPHROL DIAL TRANSPL, V17, P1771, DOI 10.1093/ndt/17.10.1771
  16. Moroni G, 1998, AM J KIDNEY DIS, V31, P681, DOI 10.1053/ajkd.1998.v31.pm9531186
  17. PASQUALI S, 1993, CLIN NEPHROL, V39, P175
  18. PASTEN VR, 2005, REV MED CHILE, V133, P23
  19. RADHAKRISHNAN J, 1994, CLIN NEPHROL, V42, P147
  20. Spetie DN, 2004, KIDNEY INT, V66, P2411, DOI 10.1111/j.1523-1755.2004.66030.x

Coleções
Artigos e Materiais de Revistas Científicas - FM/MCM
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - LIM/16