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César Augusto Restrepo Valencia, Consuelo Vélez Álvarez Abstract Objective. To evaluate the effectiveness of calcineurin ciclosporin and tacrolimus inhibitors to induce remission in patients with refractory lupus nephritis. Patients, materials and methods. Patients with lupus nephritis class IV-G who despite receiving therapy with high doses of steroid and with a cytostatic (cyclophosphamide or mycophenolate) for 3 months had not been able to induce some kind of remission.The exclusion criteria were creatinine levels greater than 3 mg / dl, pregnancy, previous history of exposure to calcineurin inhibitors, cancer, active infections, uncontrolled hypertension, and negligence with medication intake. The recommended dose of cyclosporine was 3 mg / kg / day and tacrolimus 0.1 mg / kg / day, in joint with prednisone 0.3 mg / kg / day, cyclophosphamide 1 mg / kg / day or mycophenolate mofetil 1 gram every 12 hours. The cyclophosphamide was administered only during 6 months, after which it was changed to azathioprine at doses of 1 mg / kg / day. Still, mycophenolate was continued at the same dose. All patients completed a minimum period of 12 months follow-up, it was considered that patients achieved partial remission when proteinuria decreased by 50% of the baseline value or its value decreased to less than 1 gram in 24 hours, decrease of leukocytes count and red blood cells in urine of 50%, and creatinine values were stable. A complete remission was considered when there was a reduction in proteinuria in a value less than 300 mg per 24 hours, urinary sediment with less than 3 red blood cells, less than 5 leukocyte for each high power microscopic field, and a creatinine value reduction by 50% or reaching a normal value. Results. Twelve patients met the inclusion criteria and initiated the calcineurin inhibitor protocol. Two presented accelerated deterioration in their function and required chronic dialysis therapy. Ten patients with active treatment completed 12 months of follow-up, of which 4 (40%) had partial remission (PR), 5 (50%) complete remission (RC). One patient had no significant modification to his baseline values. The following findings were made for all the patients with any significant degree of remission: their creatinine levels were reduced significantly from an average value of 1,34 +/-0,7 mg/dl to an average of 0,96 +/- 0,3 mg/dl and 0,97 +/- 0,24 mg/dl for measurements taken 6 and 12 months respectively after the start of the treatment (p<0,05). The protein levels in the urine in a timeframe of 24 hours changed from a baseline value of 2865 +/- 2586.7 milligrams to 824 +/- 981.9 milligrams at 6 months, and 488 +/- 697.7 milligrams at 12 months (p <0.05). On average, in both PR and CR patients, the C3 levels raised unlike the values for antinuclear antibodies that were diminished. No patients died, nor were there significant side effects triggered by medications. No patient presented relapses during the follow-up time. Conclusion. The calcineurin inhibitors at low doses are an important alternative to induce partial or complete remission in patients with refractory lupus nephritis compared to classic steroid and cytostatic treatment. It is required to do a long-term follow-up to establish its safety profile at low doses and relapse rate after suspension. Keywords Lupus nephritis, cyclosporine, tacrolimus. References Cameron J S. Lupus Nephritis. J Am Soc Nephrol 10:413-424. Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P, Mejía JC, Aydintug AO, Chwalinska-Sadowska H, de Ramón E, Fernández-Nebro A, Galeazzi M, Valen M, Mathieu A, Houssiau F, Caro N, Alba P, Ramos-Casals M, Ingelmo M, Hughes GR; European Working Party on Systemic Lupus Erythematosus. Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients. Medicine (Baltimore). 2003;82:299-308. Austin HA 3rd, Klippel JH, Balow JE, le Riche NG, Steinberg AD, Plotz PH, Decker JL. Therapy of lupus nephritis. Controlled trial of prednisone and cytotoxic drugs. N Engl J Med. 1986 Mar 6;314(10):614-619. Boumpas DT, Austin HA 3rd, Vaughn EM, Klippel JH, Steinberg AD, Yarboro CH, Balow JE. Controlled trial of pulse methylprednisolone versus two regimens of pulse cyclophosphamide in severe lupus nephritis. Lancet. 1992;340:741- 45. Gourley MF, Austin HA 3rd, Scott D, Yarboro CH, Vaughan EM, Muir J, Boumpas DT, Klippel JH, Balow JE, Steinberg AD. Methylprednisolone and cyclophosphamide, alone or in combination, in patients with lupus nephritis. A randomized, controlled trial. Ann Intern Med. 1996;125:549-557. Walsh M, James M, Jayne D, Tonelli M, Manns BJ, Hemmelgarn BR. 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Ann Rheum Dis. 2010;69:61. Nefropatia lúpica. Serna Flórez J, Restrepo Valencia C A en Nefrología Básica 2. Restrepo CA, Buitrago CA, Torres J, Serna J. Editorial La Patria, 2012, pág. 113-120, Manizales. KDIGO Clinical Practice Guideline for Glomerulonephritis. Kidney Int 2012;Suppl 2:143-153, Chapter 12: Lupus nephritis. American College of Rheumatology Guidelines for Screening, Treatment, and Management of Lupus Nephritis. Arthritis Care Res Volume 2012;64:797-808. The Joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendation for the management of adult and paediatric lupus nephritis. Ann Rheum Dis 2012;71:1771-1782. Griffiths B, Emery P. The treatment of lupus with cyclosporin A. Lupus. 2001;10(3):165-170. Gordon C, Matthews N, Schlesinger B C, Akbar A N, Bacon P A, Emery P, Salmon M. Active systemic lupus erythematosus is associated with the recruitment of naive/resting t cells. Rheumatology 1996;35:226-230. Favre H, Miescher P A, Huang Y P et al. Cyclosporin in the treatment of lupus nephritis. Am J Nephrol 1989;9(suppl):57-60. Rihova Z, Vankova Z, Maixnerova D, Dostal C, Jancova E, Honsova E, Merta M, Rysava R, Tesar V. Treatment of lupus nephritis with cyclosporine - an outcome analysis. Kidney Blood Press Res. 2007;30(2):124-128. Tam L S, Li E K, Leung C B, Wong K C, Lai F M M, Wang A, Szeto C C, Lui S F. Long term treatment of lupus nephritis with cyclosporin A. Q J Med 1998;91:573-580. Ferrario L, Bellone M, Bozzolo E, Baldissera E, Sabbadini M G. Remission from lupus nephritis resistant to cyclophosphamide after additional treatment with cyclosporin A. Rheumatology 2000;39:218-220. Manger K, Kalden J R, Manger B. Cyclosporin A in the treatment of systemic lupus erythematosus: results of an open clinical study. British J Rheumatology 1996;35:669-675. Tokuda M, Kurata N, Mizoguchi A, Inoh M, Seto K, Kinashi M, Takahara J. Effect of low-dose cyclosporin A on systemic lupus erythematosus disease activity. Arthritis Rheumatism 1994;37:551-558. Caccavo D, Laganà B, Mitterhofer AP, Ferri GM, Afeltra A, Amoroso A, Bonomo L. Long-term treatment of systemic lupus erythematosus with cyclosporin A. Arthritis Rheumatism 1997;40:27-35. Ogawa H, Kameda H, Amano K, Takeuchi T. Efficacy and safety of cyclosporine A in patients with refractory systemic lupus erythematosus in a daily clinical practice. Lupus 2010;19:162-169. Ogawa H, Kameda H, Nagasawa H, Sekiguchi N, Takei H, Tsuzaka K, Amano K, Takeuchi T. Prospective study of low-dose cyclosporine A in patients with refractory lupus nephritis. Mod Rheumatol 2007;17:92-97. Baca V, Catalán T, Villasís-Keever M, Ramón G, Morales AM, Rodríguez-Leyva F. Effect of low-dose cyclosporine A in the treatment of refractory proteinuria in childhood-onset lupus nephritis. Lupus 2006;15:490-495. Politt D, Heintz B, Floege J, Mertens PR. Tacrolimus- (FK 506) based immunosuppression in severe systemic lupus erythematosus. Clinical Nephrology 2004;62:49-53. Duddridge M, Powell RJ. Treatment of severe and difficult cases f systemic lupus erythematosus with tacrolimus. Areport of three cases. Ann Rheum Dis 1997;56:690-692. Uchino A, Tsukamoto H, Nakashima H, Yoshizawa S, Furugo I, Mitoma H, Oryoji K, Shimoda T, Niiro H, Tada Y, Yano T, Nonaka T, Oishi R, Akashi K, Horiuchi T. Safety and potential efficacy of tacrolimus for treatment of lupus nephritis with persistent proteinuria. Clinical Experimental Rheumatology 2010;28:6-12. Fei Y, Wu Q, Zhang W, Chen H, Hou Y, Xu D, Li M, Zhang X, Zhao Y, Zeng X, Zhang F. Low dose tacrolimus in treating lupus nephritis refractory to cyclophosphamide: a prospective cohort study. Clin Exp Rheumatol 2013;31:62-68. Gordon S, Denunzio T, Uy A. Success using tacrolimus in patients with proliferative and membranous lupus nephritis and refractory proteinuria. Hawaii J Med Public Health 2013;72:18-23. Wang S, Li X, Qu L, Wang R, Chen Y, Li Q, He X, Zhang X, Wang H, Wu J, Xu Y, Chen J. Tacrolimus versus cyclophosphamide as treatment for diffuse proliferative or membranous lupus nephritis: a non-randomized prospective cohort study. Lupus 2012;21:1025-1035. Deng J, Huo D, Wu Q, Yang Z, Liao Y. A meta-analysis of randomized controlled trials comparing tacrolimus with intravenous cyclophosphamide in the induction treatment for lupus nephritis. Tohoku J Exp Med 2012;227:281-288. Chen W, Liu Q, Chen W, Tang X, Fu P, Liu F, Liao Y, Yang Z, Zhang J, Chen J, Lou T, Fu J, Kong Y, Liu Z, Li Z, Yu X. Outcomes of maintenance therapy with tacrolimus versus azathioprine for active lupus nephritis: a multicenter randomized clinical trial. Lupus 2012;21:944-952. Full Text: PDF (Español (España)) PDF DOI: 10.22265/acnef.1.2.179 Refbacks There are currently no refbacks. Copyright (c) User Username Password Remember me This journal follows the principles and procedures given by the Committee on Publication Ethics (COPE) www.publicationethics.org Instructions for authors How to submit an article How to upload a modified version Instructions for reviewers How to review an article Instructions for associate editors How to send it to reviewers How to send corrections to authors Language Select Language Journal Content Search Search Scope Browse By Issue By Author By Title About The Authors César Augusto Restrepo Valencia Facultad de Ciencias para la Salud, Departamento de Medicina Interna, Universidad de Caldas, Manizales, Colombia Colombia Consuelo Vélez Álvarez Grupo de Investigación Promoción de la Salud y revención de la enfermedad, Facultad de Ciencias para la Salud, Departamento de Salud Pública Colombia Font Size Make font size smaller Make font size default Make font size larger Information For Readers For Authors For Librarians Indexaciones JournalTOCs Notifications View Subscribe Keywords Adolescence Biocompatible peritoneal dialysis solutions Chronic renal disease Glucose degradation products (GDP) Rejection chronic renal insufficiency education. fatty acids folic acid graft biopsy inflammation, Polivinil chloride (PVC), phthalates kidney Transplant peritoneal dialysis proteins. renal protection residual renal function. scintigraphy survival transition transplant. zinc
Autor: César Augusto Restrepo Valencia, Consuelo Vélez Álvarez
Publikováno v: Revista Colombiana de Nefrología, Vol 2, Iss 1, Pp 77-88 (2014)
Objective: To evaluate the effectiveness of calcineurin ciclosporin and tacrolimus inhibitors to induce remission in patients with refractory lupus nephritis. Patients, materials and methods: Patients with lupus nephritis class IV-G who despite recei
Externí odkaz: https://explore.openaire.eu/search/publication?articleId=doajarticles::0e5ed7fbac141766c09d3a26f76917b3
http://www.revistanefrologia.org/index.php/rcn/article/view/179/pdf
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Lead Induced Anaemia Due to Traditional Indian Medicine: A Case Report
Autor: Spriewald, B. M., Rascu, A., Schaller, K. H., Angerer, J., Kalden, J. R., Harrer, T.
Publikováno v: Occupational and Environmental Medicine, 1999 Apr 01. 56(4), 282-283.
Externí odkaz: https://www.jstor.org/stable/27731102
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80 Meilensteine der Rheumatologie aus 80 Jahren – II: 1961–1980. (German)
Autor: Schett, G., Kalden, J. R., Manger, B.
Publikováno v: Zeitschrift für Rheumatologie; Aug2021, Vol. 80 Issue 6, p506-514, 9p
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Treating Rheumatoid Arthritis to Target: multinational recommendations assessment questionnaire
Autor: Haraoui, B., Smolen, J.S., Aletaha, D., Breedveld, F.C., Burmester, G., Codreanu, C., Silva, J.P. da, Wit, M. de, Dougados, M., Durez, P., Emery, P., Fonseca, J.E., Gibofsky, A., Gomez-Reino, J., Graninger, W., Hamuryudan, V., Pena, M.J.J., Kalden, J., Kvien, T.K., Laurindo, I., Martin-Mola, E., Montecucco, C., Moreno, P.S., Pavelka, K., Poor, G., Cardiel, M.H., Stanislawska-Biernat, E., Takeuchi, T., Heijde, D. van der, Treat Target Taskforce
Publikováno v: Annals of the Rheumatic Diseases
Annals of the Rheumatic Diseases, 70(11), 1999-2002
Annals of the Rheumatic Diseases, 70(11), 1999-2002. BMJ Publishing Group
Annals of the Rheumatic Diseases, Vol. 70, no. 11, p. 1999-2002 (2011)
Haraoui, B, Smolen, J S, Aletaha, D, Breedveld, F C, Burmester, G, Codreanu, C, Da Silva, J P, de Wit, M P T, Dougados, M, Durez, P, Emery, P, Fonseca, J E, Gibofsky, A, Gomez-Reino, J, Graninger, W, Hamuryudan, V, Pena, M J J, Kalden, J, Kvien, T K, Laurindo, I, Martin-Mola, E, Montecucco, C, Moreno, P S, Pavelka, K, Poor, G, Cardiel, M H, Stanislawska-Biernat, E, Takeuchi, T & van der Heijde, D 2011, ' Treating Rheumatoid Arthritis to Target: multinational recommendations assessment questionnaire ', Annals of the Rheumatic Diseases, vol. 70, no. 11, pp. 1999-2002 . https://doi.org/10.1136/ard.2011.154179
Aim: To measure the level of agreement and application of 10 international recommendations for treating rheumatoid arthritis (RA) to a target of remission/low disease activity. Methods: A 10-point Likert scale (1=fully disagree, 10=fully agree) measu
Externí odkaz: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::2006a6bca743a1f820c81dfab2c2a5c6
https://hdl.handle.net/1871/34923
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A New Easy-to-Perform Flow Cytometry Assay for Determining Bacterial- and Viral-Infection-Induced Polymorphonuclear Neutrophil and Monocyte Membrane Marker Modulation in Febrile Patients.
Autor: La Sorda, Marilena1 (AUTHOR) marilena.lasorda@policlinicogemelli.it, De Lorenzis, Desy1 (AUTHOR) desy.delorenzis@gmail.com, Battaglia, Alessandra2 (AUTHOR) alessandra.battaglia@gmail.com, Fiori, Barbara1 (AUTHOR) barbara.fiori@policlinicogemelli.it, Graffeo, Rosalia1 (AUTHOR) rosalia.graffeo@policlinicogemelli.it, Santangelo, Rosaria1 (AUTHOR) rosaria.santangelo@policlinicogemelli.it, D'Inzeo, Tiziana1 (AUTHOR) tiziana.dinzeo@policlinicogemelli.it, De Pascale, Gennaro3 (AUTHOR) gennarodepascale@policlinicogemelli.it, Schinzari, Giovanni4 (AUTHOR) giovanni.schinzari@policlinicogemelli.it, Pedone, Romina Rose4 (AUTHOR) rominarose.pedone@guest.policlinicogemelli.it, Rossi, Ernesto4 (AUTHOR) ernesto.rossi@policlinicogemelli.it, Sanguinetti, Maurizio1,5 (AUTHOR) maurizio.sanguinetti@policlinicogemelli.it, Sali, Michela1,5 (AUTHOR) michela.sali@policlinicogemelli.it, Fattorossi, Andrea6 (AUTHOR) andrea.fattorossi@policlinicogemelli.it
Publikováno v: International Journal of Molecular Sciences. Nov2024, Vol. 25 Issue 21, p11632. 16p.
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HUMORAL AND CELLULAR IMMUNE REACTIONS IN VITRO AGAINST ALLOGENEIC AND AUTOLOGOUS HUMAN MELANOMA CELLS.
Autor: Peter, H.-H.1, Kalden, J. R.1, Seeland, P.1, Diehl, V.1, Diehl, G.2
Publikováno v: Clinical & Experimental Immunology. May1975, Vol. 20 Issue 2, p193-207. 15p.
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