Acute renal failure in paediatric systemic lupus erythematosus: treatment and outcome

被引:27
作者
Benseler, S. M. [1 ,2 ,3 ]
Bargman, J. M. [4 ]
Feldman, B. M. [1 ,2 ,3 ]
Tyrrell, P. N. [1 ]
Harvey, E. [5 ]
Hebert, D. [5 ]
Silverman, E. D. [1 ,6 ]
机构
[1] Hosp Sick Children, Div Rheumatol, Dept Pediat, Toronto, ON M5G 1X8, Canada
[2] Hosp Sick Children, Res Inst, Toronto, ON M5G 1X8, Canada
[3] Univ Toronto, Dept Hlth Policy Management & Evaluat, Univ Hlth Network, Toronto, ON M5S 1A1, Canada
[4] Univ Toronto, Div Nephrol, Dept Med, Univ Hlth Network, Toronto, ON M5S 1A1, Canada
[5] Hosp Sick Children, Div Nephrol, Dept Paediat, Toronto, ON M5G 1X8, Canada
[6] Univ Toronto, Dept Immunol, Toronto, ON, Canada
关键词
DISEASE-ACTIVITY INDEX; TERM FOLLOW-UP; INTRAVENOUS CYCLOPHOSPHAMIDE; PROPENSITY SCORE; SINGLE-CENTER; LONG-TERM; IMMUNOSUPPRESSIVE THERAPY; MYCOPHENOLATE-MOFETIL; DAMAGE INDEX; NEPHRITIS;
D O I
10.1093/rheumatology/ken445
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective. To determine the outcome of paediatric SLE (pSLE) patients with nephritis who developed acute renal failure (ARF). Efficacy and safety of treatment regimens were compared. Methods. A total of 249 pSLE patients were diagnosed and prospectively followed at a single centre between July 1973 and July 2003; 127 children (51) had lupus nephritis. ARF was defined as serum creatinine of 250 mol/l or 75 above baseline. Standardized assessments included clinical data and medications, laboratory testing, disease activity and damage scores were obtained. Subsequent renal flares were documented. Primary outcome: renal function at last follow-up. Secondary outcomes: treatment efficacy and safety. AZA- and cyclophosphamide (CYCLO)-treated patients were compared. Propensity score methods were applied to balance covariates. An intention to treat approach was chosen. Results. The ARF study cohort included 50 patients; 13 boys and 37 girls with a median age of 13.2 yrs at diagnosis and a mean follow-up of 45 months. Renal histology: Class III nephritis in 16; Class IV in 34. Dialysis requirement and disease activity were similar in both groups. Treatment: AZA in 33 patients, CYCLO in 9 and corticosteroids only in 8. Outcome: no statistically significant or clinically relevant differences were found for any of the outcome measures including last serum creatinine, time to renal flare, overall renal survival, disease activity over time, disease damage, mean annual corticosteroid dose and rate of infection. Conclusion. The treatment of renal failure in this pSLE cohort was associated with an excellent outcome. AZA and CYCLO were equally efficacious.
引用
收藏
页码:176 / 182
页数:7
相关论文
共 35 条
[1]   Systemic lupus erythematosus in Trinidadian children [J].
Balkaran, BN ;
Roberts, LA ;
Ramcharan, J .
ANNALS OF TROPICAL PAEDIATRICS, 2004, 24 (03) :241-244
[2]   Treatment of lupus nephritis: A meta-analysis of clinical trials [J].
Bansal, VK ;
Beto, JA .
AMERICAN JOURNAL OF KIDNEY DISEASES, 1997, 29 (02) :193-199
[3]  
Barbano G, 2002, J NEPHROL, V15, P123
[4]   Lupus nephritis in childhood: a review of 53 patients followed at a single center [J].
Bogdanovic, R ;
Nikolic, V ;
Pasic, S ;
Dimitrijevic, J ;
Lipkovska-Markovic, J ;
Eric-Marinkovic, J ;
Ognjanovic, M ;
Minic, A ;
Stajic, N .
PEDIATRIC NEPHROLOGY, 2004, 19 (01) :36-44
[5]   DERIVATION OF THE SLEDAI - A DISEASE-ACTIVITY INDEX FOR LUPUS PATIENTS [J].
BOMBARDIER, C ;
GLADMAN, DD ;
UROWITZ, MB ;
CARON, D ;
CHANG, CH .
ARTHRITIS AND RHEUMATISM, 1992, 35 (06) :630-640
[6]   European Consensus Lupus Activity Measurement is sensitive to change in disease activity in childhood-onset systemic lupus erythematosus [J].
Brunner, HI ;
Silverman, ED ;
Bombardier, C ;
Feldman, BM .
ARTHRITIS & RHEUMATISM-ARTHRITIS CARE & RESEARCH, 2003, 49 (03) :335-341
[7]   Long-term study of mycophenolate mofetil as continuous induction and maintenance treatment for diffuse proliferative lupus nephritis [J].
Chan, TM ;
Tse, KC ;
Tang, CSO ;
Mok, MY ;
Li, FK .
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2005, 16 (04) :1076-1084
[8]   Sequential therapies for proliferative lupus nephritis [J].
Contreras, G ;
Pardo, V ;
Leclercq, B ;
Lenz, O ;
Tozman, E ;
O'Nan, P ;
Roth, D .
NEW ENGLAND JOURNAL OF MEDICINE, 2004, 350 (10) :971-980
[9]  
D'Agostino RB, 1998, STAT MED, V17, P2265, DOI 10.1002/(SICI)1097-0258(19981015)17:19<2265::AID-SIM918>3.0.CO
[10]  
2-B