Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0024141 (systemic lupus erythematosus)
 44,322 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Although many reports have been made on the effectiveness of plasma exchange (PE) in active systemic lupus erythematosus (SLE), but there are no clear-cut criteria of indication for lupus nephritis (LN). In order to determine the criteria for indication of LN, 35 patients with LN treated by PE were studied with respect to renal function (F), proteinuria (P), immunological activity (A) and renal histology. The patients were divided into 4 groups according to the severity of renal function: F1 (stable chronic renal failure (CRF) or stable renal function n = 13), F2 (relapse type n = 9), F3 (rapidly progressive LN; creatinine clearance (Ccr) less than 40 ml/min n = 7) and F4 (acute renal failure; Ccr less than 10 ml/min n = 6). Proteinuria was also studied in 4 groups: P1 & P2 (without nephrotic syndrome (NS], P3 (acute type NS n = 15), and P4 (chronic type NS n = 7). These patients were divided into 3 groups to study immunological activity: A1 (chronic stage n = 6), A2 (relapse stage n = 12) and A3 (active stage n = 17). Comparison was made in each parameter. Renal histological classification according to WHO criteria of LN, activity score (AS) and chronicity score (CS) were evaluated and compared. As a result, the following indication was obtained. 1) ABSOLUTE INDICATION: 1. Rapidly progressive LN with high immunological activity; elevated serum creatinine (SCr) greater than 1.0 mg/dl/month or decreased Ccr from normal renal function to less than 40 ml/min within 1-2 months after onset. 2. Acute type NS within 1 year after onset. 3. histological AS greater than 20. 2) RELATIVE INDICATION: 1. Relapse LN with moderate immunological activity, decreased Ccr from normal function to 40-50 ml/min within 3-6 months, the rise in SCr of greater than 1.0 mg/dl/month. 2. Proteinuria is 1.0-3.5 g/day within 1 year after onset. 3. Such complication as CNS, serositis, thrombocytopenia and leukopenia, steroid resistance and/or severe side effects of steroid. 3) NO INDICATION: 1. CRF or stable renal function (Ccr greater than 50 ml/min). 2. Chronic type NS over 1 years with past history of NS and/or edema. 3. Low immunological activity and mild renal histology.
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PMID:[The criteria for indication of plasma exchange on lupus nephritis]. 221 18

Twenty cases of systemic lupus erythematosus (SLE) in prepubertal children (less than 14 years of age) were seen over a period of 14 years. The male:female ratio was 1:2.3, and the mean age at onset was 9.37 years. Fever with joint involvement was the commonest presenting manifestation (60%), followed by nephrotic syndrome (25%). Notable clinical features included a high incidence of renal involvement (75%), significant hypertension (45%) and reversibility of acute renal failure (2 cases). The other organs and systems involved included: mucocutaneous manifestations (60%), cardiovascular system (30%), respiratory system (25%), neuropsychiatric manifestations (45%), and anemia (75%). Raynaud's phenomenon and thrombocytopenia were rare while leucopenia was not seen in a single patient. Immunological abnormalities noted were 100% positivity for antinuclear antibodies, and 87.5 and 75% positivity for antibodies to double-stranded and single-stranded DNA, respectively. Hypocomplementemia was seen in 75% of patients tested.
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PMID:Systemic lupus erythematosus in Indian children. 263 4

The cost/benefit ratio of renal biopsy defines the mandatory indications in situations where histologic diagnosis is required for the choice of treatment and for predicting the evolution of renal function. These indications include nephrotic syndrome, permanent proteinuria associated with microhematuria or not, rapidly progressive nephropathies, and, at least in some authors' view, systemic lupus erythematosus. Additional indications should be considered in patients presenting with acute renal failure of unknown origin, renal involvement accompanying systemic diseases, isolated microhematuria and intermittent proteinuria. In these latter indications histology allows the choice of specific therapy in some 20% of cases; the evolution of renal function can be correctly evaluated in 90% of cases. Patients usually consider renal biopsy a benign investigation which helps them to cope with their disease on the basis of a definite diagnosis.
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PMID:[Indications for renal biopsy]. 274 17

A 46 year old white woman with active systemic lupus erythematosus developed a skin rash 8 hours after intravenous urography with the non-ionic contrast medium iopamidol. Severe Stevens-Johnson syndrome with erythema multiforme, intrahepatic cholestasis, pulmonary infiltrates and acute renal failure ensued, leading to her death. Although non-ionic contrast media are generally less toxic than traditional ionic agents, their use in patients with immunological disease may be hazardous.
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PMID:Fatal Stevens-Johnson syndrome following urography with iopamidol in systemic lupus erythematosus. 320 Jul 83

Patients with lupus nephritis and severe renal failure progress to end-stage renal disease despite aggressive therapy to suppress immunologic function. Within this group is a small subset presenting with rapid progression of renal failure and requiring dialytic support. We reviewed the clinicopathologic data of four such patients who were able to terminate dialysis after acute renal failure due to lupus nephritis. Three of these patients have remained independent of dialysis up to 4 years, and one patient returned to dialysis 1 month following discontinuation. Although glomerular pathology was variable in the four patients, a lesion common to all at presentation was acute tubular necrosis. It is suggested that tubular necrosis may cause reversible renal failure when part of the nephropathy of disseminated lupus treated with corticosteroids.
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PMID:Histopathologic evaluation of lupus patients with transient renal failure. 381 70

Antirheumatic drugs may cause a significant, although generally reversible, reduction of GFR, RPF, CNa and hyperkalemia in a wide range of extrarenal and renal disease states (severe liver disease, congestive heart failure, SLE, nephrotic syndrome, etc.); chronic ingestion has been associated with analgesic nephropathy. Recently cases have been reported of reversible acute renal failure with massive proteinuria and interstitial nephritis. The acute effects of a renal PG-inhibiting (ibuprofen) or a renal PG-sparing (sulindac) cyclo-oxygenase inhibitor on renal functional parameters (GFR, RPF, CNa, CK, urine volume) and proteinuria have been studied in 24 patients with clinically and biopsy proven chronic glomerular disease; in all patients ibuprofen significantly reduced GFR, RPF, CNa; these changes were fully reversible within a week of withdrawal of the drugs. A causal relationship exists between inhibited PG-synthesis and reduced renal function in these patients, since sulindac, which failed to reduce urinary PG excretion did not alter significantly the renal function. Moreover proteinuria is not reduced by ibuprofen at doses comparable, as far as concerns inhibition of PG-synthesis, to those of indomethacin.
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PMID:Clinical assessment of the renal toxicity of antirheumatic drugs. 633 23

We describe 26 pregnancies in 19 patients with lupus nephritis. There were 4 spontaneous abortions, 2 therapeutic abortions, 4 stillbirths and 1 neonatal death. 10 deliveries were preterm and 2 fetuses were small for gestational age. 8 pregnancies were not accompanied by change of renal symptoms. Mild signs of renal involvement appeared during pregnancy in 4 patients. 6 patients showed an increase in proteinuria already present before pregnancy without renal function deterioration. A moderate worsening of renal function was observed in 3 patients. 4 patients, 3 of whom had an apparent onset of systemic lupus erythematosus during pregnancy, developed anuric acute renal failure after delivery or after late spontaneous abortion. 2 of them died from sepsis and disseminated intravascular coagulation while 2 had complete recovery of renal function. A high rate of complications was observed in patients not adequately treated during pregnancy. Renal biopsy before gestation was not predictive of the outcome of nephropathy during pregnancy, and change of histology in repeated biopsies was frequently observed.
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PMID:Lupus nephropathy and pregnancy. A study of 26 pregnancies in patients with systemic lupus erythematosus and nephritis. 669 Oct 1

Crescentic lupus glomerulonephritis (greater than or equal to 50% crescents) occurred in 16% of systemic lupus erythematosus (SLE) patients biopsied over a 32-month period. All had underlying WHO class IV lupus nephritis. These patients more frequently manifested with acute renal failure usually of the non-oliguric type, had heavier proteinuria and lower serum albumin, but were otherwise indistinguishable from non-crescentic WHO class IV lupus nephritis in their other renal and extrarenal manifestations or in their serological findings. Crescentic lupus glomerulonephritis may occur in patients at first presentation with SLE, or develop in patients after prolonged follow-up initially for lupus nephritis of WHO class IV or other classes. Combined methylprednisolone pulse therapy, immunosuppressives, antiplatelet agents with or without anticoagulant produced good initial responses. Prognosis was unfavorable for inadequately treated patients or for patients with persistent nephrotic syndrome and crescents.
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PMID:Crescentic lupus glomerulonephritis. 673 93

In two patients with systemic lupus erythematosus, acute renal failure was the initial manifestation. The diagnosis was eventually established on the basis of serologic tests and characteristic renal histopathologic findings. We emphasize the need to consider systemic lupus erythematosus as a cause of acute renal failure of glomerular origin, because appropriate therapy may alter the outcome of the disease.
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PMID:Acute renal failure as the initial manifestation of systemic lupus erythematosus in children. 673 47

Acute interstitial pneumonitis is a well-recognized, although rare, complication of systemic lupus erythematosus (SLE) that has been associated with a poor prognosis. Fulminant lupus pneumonitis, acute renal failure, and RBC hypoplasia occurred in a 14-year-old girl. The patient's condition was managed with large-volume plasmapharesis, dialysis, and immunosuppressive therapy. Her respiratory, renal, and hematologic changes all resolved, and response was maintained with cyclophosphamide and prednisolone therapy. Although serologic evidence of SLE persisted, clinically, the patient was well four years after the initial appearance of SLE. There are several acute pulmonary manifestations of SLE, and plasmapheresis may be useful in the management of some of these conditions.
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PMID:Fulminant lupus pneumonitis with acute renal failure and RBC aplasia. Successful management with plasmapheresis and immunosuppression. 724 96


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