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Query: UMLS:C0024141 (systemic lupus erythematosus)
 44,322 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To determine the clinical characteristics and long-term prognosis of 11 Japanese systemic lupus erythematosus (SLE) patients who were starting dialysis, we studied the clinicopathological findings before dialysis and during the clinical course after dialysis. Patients were divided into three groups: Group A consisting of temporary dialysis patients (n = 5); Group B consisting of early-death patient (n = 1); and Group C consisting of maintenance dialysis patients (n = 6). At the start of dialysis, the progression pattern of renal failure in all Group A patients was either acute exacerbation of chronic renal failure (CRF) or rapidly progressive glomerulonephritis (RPGN). The pattern in Group C was mostly CRF (83%). Three patients from Group A and three from Group C were still alive at the latest follow-up (mean follow-up period was 11.0 years, ranging from 1.8 to 16.2 years) and they showed no signs of clinical or serological activity. Infection was the cause of death in 3 of the 5 patients who died. We suggest that dialysis can be discontinued in patients with SLE who receive dialysis for acute exacerbation of CRF or RPGN. After the initiation of dialysis, patients tend to show diminished SLE activity. Infection is the major contributor to the poor prognosis of SLE patients receiving dialysis.
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PMID:Clinicopathological study of dialysis patients with lupus nephritis. 756 54

A 39-year-old woman with the diagnosis of mitral regurgitation was admitted to our hospital for surgical treatment. Cerebral thromboembolism and spontaneous abortion had been repeated in her past history. She was suffered from chronic renal failure associated with systemic lupus erythematosus (SLE) and anti-phospholipid syndrome (APS). An operative procedure was recommended because of the progressive heart failure due to mitral regurgitation. For renal failure, continuous ambulatory peritoneal dialysis (CAPD) was introduced at one month before operation. As the operative procedure, valve replacement using Carpentier-Edwards bioprosthesis (27 mm) was done rather than valve reconstruction, because chordal rupture of posterior leaflet and severe hypertrophy of both leaflets were recognized. During operation, uncontrollable bleeding was not observed. However, platelet transfusion was needed. We use warfarin and antiplatelet agents jointly as postoperative anticoagulant therapy. Thromboembolic episodes have not been observed 4 years postoperatively. Relationship between SLE with APS and cardiac valvular lesions has been focused. The present case was considered to be the interesting case which various devices were necessary to operative management including chronic renal failure, cardiopulmonary bypass, selection of prosthetic heart valve, and postoperative anticoagulant therapy for preventing thrombus formation.
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PMID:[Successful surgical treatment of mitral regurgitation associated with anti-phospholipid syndrome and systemic lupus erythematosus]. 759 55

Lupus nephritis remains an important problem in patients with systemic lupus erythematosus (SLE). Some patients with diffuse proliferative lupus nephritis (DPLN) develop chronic renal failure (CRF). A case-control study was designed to determine the variables associated with CRF in patients with DPLN. We studied 121 patients with biopsy-proven DPLN seen in our institution from 1970 to 1988. There were 34 patients who developed CRF, the remaining were their controls. Clinical charts were reviewed and a pathologist re-scored blindly both activity and chronicity indices. The mean of age at SLE onset was 24.1 +/- 7.9 years; the mean disease duration was 9.2 +/- 6.1 years for controls and 6.1 +/- 5 years for patients. The main variables associated with CRF were male sex. HR (hazard ratio): 12.6 (95% CI 1.6-98.2); activity index, HR 2.59 (1.07-6.3); severe infections, HR 2.9 (1.2-7.3): number of antihypertensive drugs, HR 2.5 (1.4-4.7); cellular crescents, HR 1.6 (1.2-2): and interstitial inflammation, HR 2.7 (1.5-5.1). A protective effect was observed with longer use of < or = 20 mg of prednisone, HR 0.53 (95% CI 0.34-08): azathioprine, HR 0.6 (0.4-0.8); and length of formal education. HR 0.3 (0.09-0.94). Our results indicate that maleness, activity index, extracapillary proliferation and interstitial inflammation, as well as hypertension and severe infections associate with CRF in patients with DPLN, and treatment and higher education, perhaps through better therapeutic compliance, may be protective.
Lupus 1995 Jun
PMID:Factors associated with chronic renal failure in 121 patients with diffuse proliferative lupus nephritis: a case-control study. 765 89

A 31-year-old woman with systemic lupus erythematosus (SLE), diabetes mellitus, and chronic renal failure developed digital ischemia, myocardial dysfunction, abnormal ECG, and elevated CPK levels. Radiographic studies revealed calcification of the peripheral vasculature although coronary angiography was unremarkable. An endomyocardial biopsy demonstrated intra and extracellular myocardial calcification without evidence of vasculitis or primary myocarditis. A diagnosis of calciphylaxis, as a result of secondary hyperparathyroidism, was made. This case demonstrates that calciphylaxis can mimic the cardiovascular manifestations of SLE. Early differentiation of these disparate diseases is important because treatment strategies employed in SLE may exacerbate calciphylaxis.
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PMID:Systemic lupus erythematosus: calciphylaxis induced cardiomyopathy. 769 81

Intravenous immune globulin (IVIg) has been advocated as efficacious therapy for a variety of disorders including idiopathic thrombocytopenic purpura and Kawasaki disease. Several reports have also documented the effectiveness of IVIg in systemic lupus erythematosus (SLE). Two patients with symptomatic SLE and ESRD were treated with IVIg. Both patients tolerated IVIg administration well and demonstrated clinical and serologic improvement. Both individuals also experienced a transient decline in serum albumin concentration with IVIg treatment. The mechanisms by which IVIg might have effected improvement in these patients are varied and are likely related to the immunomodulatory actions of IVIg. The reversible change in albumin concentration seen in these individuals may be secondary to abrupt alterations in oncotic homeostasis. Despite this unusual effect, the documented improvement in these patients suggests that IVIg therapy may be of benefit in patients with active SLE and ESRD. Further studies are warranted to examine the mechanisms by which IVIg may exert its therapeutic effect.
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PMID:Intravenous immune globulin in the treatment of patients with systemic lupus erythematosus and end-stage renal disease. 778 41

Renal involvement in systemic lupus erythematosus (SLE) often signifies a poor prognosis. Whilst SLE appears to be not uncommon in the racial groups of South Africa, there are few reports in the literature. Between 1984 and 1987, 43 patients with SLE and nephritis were analyzed. Clinical and biochemical manifestations are described. The histological types (WHO classification) were mainly class II (15 cases) and class IV (17 cases). The ratio of black to Indian patients was 26.4% in class II and 43.4% in class IV to 42% each in class II and class IV respectively. Immunofluorescence showed a predominantly granular pattern of IgG, C1 and C3. Treatment was with combinations of prednisone and cyclophosphamide (14 cases), prednisone and azathioprine (21 cases) or pulse methylprednisolone (6 cases; total 41 cases). Two patients were not treated. There was no difference between cyclophosphamide and prednisone (14 cases) and prednisone with azathioprine (21 cases) treatment groups. The follow-up period was for 4 years. Mortality occurred in 15 patients (35%). The main cause of death was renal failure in 10 patients, infection in 1 patient and central nervous system involvement in 1 patient. The prognosis was worse in the Indian compared with the black patients. The WHO classification did not give an accurate prognosis regarding mortality in our study. Because of limited resources for the treatment of chronic renal failure in developing countries, we feel that patients with lupus nephritis should be treated with improved ancillary medical therapies and more effective immunosuppressive regimens.
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PMID:Systemic lupus erythematosus and renal involvement. A South African experience. 801 46

The role of laparoscopy in the diagnostic evaluation of ascites of unknown origin was studied in 129 patients. Laparoscopic results were as follows: (1) Carcinomatosis peritonei in 78 (60.5%). Peritoneal biopsies in 76 of these cases revealed malignancy in 67 (adenocarcinoma 62, lymphoma 4, mesothelioma 1) and tuberculosis in 5; specimens were inadequate for diagnosis in 4. (2) Tuberculous peritonitis in 26 (20.2%). Peritoneal biopsies in 24 of these cases revealed tuberculosis in 22 and non-specific chronic peritonitis in 2. (3) Cirrhosis in 7 (5.4%). (4) No gross abnormality in 18 (14.0%). Of the latter, causes of ascites had already been identified in 13 (72.2%), including chronic renal failure in 7, systemic lupus erythematosus in 2, constrictive pericarditis in 2, chronic pancreatitis with chylous ascites in 1, and retroperitoneal lymph node metastasis with chylous ascites in 1. Thus, laparoscopic observation in combination with biopsy established the cause of ascites of unknown origin in 111 (86.0%) of 129 patients. Most of the 18 patients without gross laparoscopic abnormality had underlying disease identified as a cause of ascites; laparoscopy was indicated in these cases to exclude other processes that may also cause ascites.
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PMID:The role of laparoscopy in the evaluation of ascites of unknown origin. 805 29

End-stage renal disease (ESRD) is one of the most significant complications of systemic lupus erythematosus (SLE). Previous investigators have evaluated the morbidity and mortality of different renal replacement treatment modalities in these patients. Earlier reports have suggested that the systemic manifestations of SLE diminish, or "burn out," once ESRD occurs. These investigators also suggested that vascular access complications were a significant cause of morbidity and mortality in these patients treated with hemodialysis (HD). A retrospective review of the records of 6 patients with ESRD from lupus nephritis (LN), who received both HD and peritoneal dialysis (PD), was performed to determine if there was a difference in disease activity between treatment modalities, using patients as self-controls. The number of SLE flares was determined by clinical and/or serologic studies, and prednisone dosages compared for each treatment modality. Four of the 6 patients continued to have active SLE after renal replacement therapy was begun. There were no significant differences in the number of SLE flares or prednisone dosages while receiving either treatment modality. While PD eliminates problems associated with vascular access, both HD and PD were effective forms of renal replacement therapy. Most patients in this study continued to have active SLE after commencement of dialysis, with no differences in disease activity noted during HD or PD.
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PMID:Treatment of end-stage renal disease due to lupus nephritis: comparison of six patients treated with both peritoneal and hemodialysis. 810 10

This paper reports a case of peritonitis by Nocardia asteroides during continuous ambulatory peritoneal dialysis in a man who had systemic lupus erythematous and chronic renal failure. Diagnosis was established by microscopic examination (Gram and Kinyoun) and culture of centrifuged dialysis fluid and the patient was treated with Trimethoprim-Sulfamethoxazole by intraperitoneal route.
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PMID:Nocardia asteroides peritonitis during continuous ambulatory peritoneal dialysis. 811

Cytomegalovirus (CMV) infection is serious complication after clinical renal transplantation. A case of CMV hepatitis and nephropathy after living related renal transplantation was reported. A 32-year-old women with chronic renal failure due to systemic lupus erythematosis received a renal transplant from her mother. On day 35 after operation, she developed high fever with hepatic and renal damage and was diagnosed as CMV infection from clinical course and virological examination. Although the use of anti-CMV high titer gamma globulin with reduction of immunosuppressant therapy could not cure the infection, the administration of Ganciclovir improved hepatic and renal damage without deterioration of renal graft function.
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PMID:[A case report of CMV hepatitis and nephropathy after living related renal transplantation]. 827 70


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