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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. 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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. 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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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