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)

Adverse effects of converting enzyme inhibitors are either substance-specific (neutropenia, proteinuria, skin rashes, taste disturbances) or due to the converting enzyme inhibition (hypotension, functional renal insufficiency, hyperkalemia, cough, angioedema). They are rare nowadays because of better knowledge of the pharmacokinetics and -dynamics of the converting enzyme inhibitors, resulting in lower dosage, and because of identifying patients at high risk. The dosage must be adjusted according to renal function, in order to prevent accumulation and toxicity. In addition to patients with renal insufficiency, patients at high risk are those with a stimulated renin-angiotensin-aldosterone system, i.e. patients with renovascular hypertension or heart failure. Patients with collagen vascular disease, for example, systemic lupus erythematosus or scleroderma, should not be considered for long-term therapy with converting enzyme inhibitors because of the increased risk of neutropenia. Life-threatening angioedema may develop, mainly during the first few hours after drug administration.
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PMID:[Angiotensin-converting enzyme inhibition: side effects and risks]. 285 Jun 87

Murine lupus in NZB/NZW F1 (B/W) mice can be prevented by weekly treatment with monoclonal antibodies (MAb) to L3T4 (on "helper/inducer" T cells) if treatment is begun prior to the onset of clinical illness. To determine whether anti-L3T4 could reverse as well as prevent murine lupus, we monitored a cohort of 30 B/W females until age 7 mo, when severe autoimmune disease was established, and then we examined the effects of weekly treatment with MAb to L3T4. The rate of target cell clearance by MAb was considerably slower in old B/W mice than it was in young B/W mice or in normal (BALB/c and C57BL/6) mice. Nonetheless, treatment with anti-L3T4 depleted 90% of circulating L3T4+ cells over 3 mo. In treated mice, the concentration of anti-DNA antibodies fell by 80%, renal insufficiency was reversed, and 1 yr survival was 75% compared to 17% in controls. These findings indicate that L3T4+ cells play an important role in perpetuating murine lupus in B/W mice even after severe disease is present. Because the L3T4 antigen in mice is homologous to the Leu-3/T4 (CD4) antigen in humans, these findings suggest that treatment with CD4 MAb may be effective in people with systemic lupus erythematosus.
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PMID:Reversal of advanced murine lupus in NZB/NZW F1 mice by treatment with monoclonal antibody to L3T4. 310 78

Over a 13-year period 42 patients (35 women) with systemic lupus erythematosus and renal disease had a renal biopsy. Renal involvement as the first and only manifestation of systemic lupus erythematosus was common in men. The commonest reason for renal biopsy (23/42) was the finding of proteinuria with or without haematuria. One-half of all patients had diffuse proliferative glomerulonephritis. Twenty-seven patients were treated with both prednisone and azathioprine and 10 with prednisone alone at some stage during follow-up. The renal biopsy findings were useful in assessing the severity of renal involvement and prognosis. A five-year renal survival of 72% was observed. Diffuse proliferative glomerulonephritis with renal insufficiency was associated with a poor prognosis. Those patients who were established on the dialysis/transplant programme became symptom free on no treatment.
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PMID:Lupus nephritis: a 13-year experience. 346 14

Antinuclear antibodies (ANA) are found in the majority of patients with systemic lupus erythematosus (SLE). We report here the only documented case, out of a series of 38 patients, in which SLE was diagnosed in spite of the fact that we failed to demonstrate any type of autoantibodies. A 25-year-old black woman presented with 6 of the 11 criteria of the American Rheumatism Association for classification of SLE, between August 1984 and April 1985, i.e. malar rash, photosensitivity, arthritis, pleurisy and pericarditis, renal insufficiency and nephrotic syndrome, anemia and leukopenia. Renal biopsy revealed mesangial glomerulonephritis, tubulonephritis and many tubuloreticular inclusions in the capillary endothelium highly suggestive of SLE. Four ANA determinations were performed during the 8 months of observation which were all negative, as were all other antibodies (anti-nDNA, -Sm, -RPN, -Ro, -La). The outcome was very favourable under prednisone and cyclophosphamide. In the rare cases of ANA negative SLE (5-10%) photosensitive dermatitis is the prominent feature and renal or central nervous system involvement is less frequent. Those patients usually have other types of autoantibodies (especially anticytoplasmic) which was not the case in our patient. This indicates that the absence of autoantibodies does not rule out SLE.
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PMID:[Disseminated lupus erythematosus without antinuclear antibodies or other autoantibodies]. 349 6

To determine whether patients with systemic lupus erythematosus (SLE) and active nephritis have more profound defects in cell-mediated immunity (CMI), we studied T-colony-forming cells (TCFC) in 12 patients with lupus nephritis (LN) and 14 patients with chronic mesangial proliferative glomerulonephritis (CGN) without renal insufficiency. We also examined the activity of T-colony-stimulating factor (TCSF) in media conditioned by phytohaemagglutinin (PHA) stimulated peripheral blood lymphocytes (PHA-LCM). The levels of TCFC and TCSF were decreased in patients with LN compared with those in normal controls and lower in LN patients with the nephrotic syndrome (NS) than in those without NS. In contrast, these CMI parameters in CGN patients with or without NS did not differ from normal subjects. TCSF activity for TCFC in both normal individuals and LN patients was removed from PHA-LCM with interleukin 2 (IL 2) receptor bearing cultured T cells. These in vitro findings suggest that IL 2 is the essential factor contained in PHA-LCM. Our observations may lend further insight into the understanding of the immunoregulatory defect in LN.
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PMID:Defective T-lymphocyte colony formation in patients with lupus nephritis. 350 75

In summary, evidence exists that immunologically mediated renal diseases can be modulated by interfering with the mechanism of production of autoantibodies by specific antiidiotypic immunity. However, more studies are necessary to establish efficient and safe parameters from which to suggest such treatment in human immune nephritides. Although the evidence is still circumstantial, it is necessary to keep in mind that antiidiotypic antibodies may also add to glomerular immune deposits and potentially could contribute to the chronicity of some forms of immunologic nephritis. The fate of the majority of immunologic nephritides is a slow progression toward end-stage renal insufficiency. Although in most cases the etiology remains to be determined, it is generally felt that a better understanding of the initial immune dysregulation may lead to a greater possibility of control and cure. In this perspective, new directions of research, such as the one reviewed here, should be considered. Modulation of the damaging autoimmune responses in SLE or Goodpasture's Syndrome might be possible. For instance, the identification of a cross-reacting idiotype among anti-GBM antibodies would be the first step for a possible future use of natural or synthetic idiotypes for autovaccination purposes. Antiidiotype antibodies, particularly in the form of monoclonal chimaeric (mouse/human) hybridomas, could be utilized for passive immunosuppression, particularly in combination with plasmapheresis, with or without conventional immunosuppressive drugs. Clearly, this is part of a long-term process that may or may not be realized. The success of new forms of specific immunologic treatment for kidney diseases may ultimately depend upon ongoing efforts in the study of the new molecular aspects of regulation of potential nephritogenic immune responses.
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PMID:A role for antiidiotypic antibodies in immunologically mediated nephritis. 352 Dec 65

Hyperkalemia has been noted to occur spontaneously in patients with long-standing systemic lupus erythematosus who did not have advanced renal insufficiency. The patients previously described all had relatively normal renin-aldosterone systems, and the hyperkalemia was thus presumed to be secondary to a primary defect in renal tubular potassium secretion. We describe at 10-year-old girl with lupus nephritis, without significant renal insufficiency, who had hyperkalemia from hyporeninemic hypoaldosteronism postulated to be due to vasculitis involving the afferent/efferent arterioles and juxtaglomerular apparatus.
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PMID:Systemic lupus erythematosus presenting with hyporeninemic hypoaldosteronism in a 10-year-old girl. 353 7

The results are reported from the treatment of 17 patients with diffuse glomerulonephritis in lupus erythematodes disseminatus (16 females and I male, aged from 16 to 54, average age of 29.0), carried out during the period 1976-1982. All patients were treated with a combination of anticoagulants, corticosteroids and immunosuppressives in the course of II to 82 months (23.9 months on the average). By the end of 1978, corticosteroids were administered 3 times daily, whereafter--once in the morning or every second day. Complete clinical-laboratory remission was attained in 13 patients (76.4%). Any treatment to those patients was discontinued for 19 to 86 months (54.6 months on the average). Only in one patients recurrence was observed, coped with the respective treatment. Two of the patients died, after 43 and 82-month treatment respectively, of pulmonary pneumonia and another 2--of complications: associated with corticosteroids. With the combined treatment with anticoagulants: corticosteroids and immunosuppressives complete clinical-laboratory remission could be attained with a duration of over 4 1/2 years on the average in 3/4 of the treated. The combined treatment could preserve or restore the renal function, if renal insufficiency had not developed or developed but not very advanced. The maintenance of the complete clinical laboratory remission does not need a constant administration of corticosteroids or other pharmaceuticals. Lethality in the patients with diffuse lupus glomerulonephritis is still high. The single and alternative administration of corticosteroids reduces the risk of adverse effects.
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PMID:[Survival of patients with diffuse glomerulonephritis in disseminated lupus erythematosus treated with a combination of anticoagulants, corticosteroids and immunosuppressants]. 359 Jul 22

A retrospective study was made of 137 children with systemic lupus erythematosus (SLE) seen at the Veterans General Hospital in the past 12 years. There were 116 females (84.7%), and 21 males (15.3%). The peak ages of onset were 13-14 years and 16-17 years. Malar rash, arthritis and fever were the most common presentations, as in previous studies. Central nervous system (CNS) involvement occurred in 24 cases (17.5%), and renal disorder was noted in 77 cases (56.2%). Renal biopsy in 67 cases showed a pathological transformation rate of 16.1% (5/31). Ten patients died during the study period, with renal insufficiency the primary cause of death.
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PMID:Systemic lupus erythematosus in children. 359 62

Adolescents constitute a particular group of patients because of their young age and incomplete or erroneous knowledge of contraception and reproduction. The physical condition of a young girl and the medical history of her close relatives must be assessed in the contraception consultation. In the absence of obvious contraindications such as hypertension, diabetes, hypercholesterolemia or renal insufficiency, oral contraceptives (OCs) are most often indicated, whether or not the menstrual cycle is well established. It has been demonstrated that the hypothalamus resumes its previous activity when OC use is discontinued. Standard-dosed combined OCs are usually recommended, because low-dose formulations do not always sufficiently block the hypothalamus and may induce a state of relative hyperestrogenism. Girls with benign breast disease or whose mothers have histories of breast cancer may benefit from the antigonadotropic properties of a 19-nortestosterone derivative progestin administered from the 8th to the 25th cycle days. Some 19-nortestosterone derivatives can cause seborrhea, acne, or hair loss. Sequential OCs may be indicated at this age for temporary use in exceptional cases. Low-dose progestins are not completely effective and cause worrisome menstrual problems. In cases of renal insufficiency, lupus, or hypertension, derivatives of 17-OH progesterone can be used. Cyproterone acetate is indicated for adolescents with hirsutism. Barrier methods are not used by adolescents as often as the less reliable but simpler ovules or jellies. The diaphragm with jelly or the condom correctly used are the most reliable, but they have a bad reputation. Information campaigns have successfully promoted use in some countries. IUDs are strongly contraindicated for all young girls because of increased risks of infection and sexually transmitted diseases. In extreme necessity they may be used for mentally ill adolescents unable to use any other method.
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PMID:[Contraceptive methods for adolescents]. 385 20


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