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 the etiology of lupus is imperfectly understood, immune factors, heredity, viral infections, and hormonal status are known to play a role. Studies of the sex ratio of lupus patients indicate that before age 10, twice as many girls as boys are affected, but after 12 years, 9.6 females are affected for each male. The incidence of lupus is almost constant for males of all ages but is much higher for women of fertile age than for other women. The deleterious effect of synthetic estrogens was 1st reported in 1966, and various studies since then have confirmed the results. The etiologic role of pregnancy is debated, but pregnancies can be successfully carried to term in periods of remission. Certain lines of mice spontaneously develop an autoimmune disease resembling disseminated lupus erythematosus. Anti-DNA antibodies appear earlier in the female and death from renal insufficiency occurs earlier than in males. Prepubertal castration does not influence the survival of female mice but significantly reduces that of males. Treatment with estradiol diminishes survival of castrated males and females, while treatment with androgens increases survival time of castrated to control females and of castrated males to that of control males. The timing and dose of treatment modify the response. Progesterone administered alone does not influence survival time of females but somewhat increases that of castrated males. Cyproterone acetate, an antiandrogenous progestin, has no effect in 2-3 week old males. Danazol, a moderately active androgen, has no effect on female mice. Nafoxidine, an antiestrogen, increases survival times. These results support the opinion that estrogens aggravate lupus while androgens have a protective effect. Different hormonal treatments have been prescribed for human lupus. Some beneficial effect for female patients has been observed with danazol, but the drug entails significant hepatic, metabolic, and hypertensive risks and may produce androgenic side effects such as voice modifications and hirsutism. Cyproterone acetate, a derivative of 17-hydroxyprogesterone, is without vascular and metabolic side effects and can halt ovarian function at a dose of 50 mg/day. It behaves as a peripheral antiandrogen and may have androgen agonist activity in some tissues. The mechanism of interaction of sex hormones in lupus may be explained by their influence on cellular and humoral immunity. Estrogens appear to suppress cellular immunity and stimulate humoral immunity, while androgens appear to play a suppressive role at the 2 levels. Contraception for women with lupus must be effective. Combined oral contraceptives and low-dose norsteroid progestins are contraindicated because of their thromboembolic and vascular risks. Low-dose progestins may be used but cause hyperestrogenism in some women. Chlormadinone acetate at a daily dose of 10 mg has no significant vascular effect. IUDs may have reduced efficacy during corticotherapy and pose a risk of infection. Only mechanical vaginal methods ose no threats for lupus patients, but they must be understood and accepted by the patient.
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PMID:[Hormones and lupus]. 391 21

This panel considered the clinical implications of nephrotoxicity due to nonsteroidal anti-inflammatory drugs. Although the clinical benefits and safety of these agents are well established, the drugs may adversely affect renal perfusion, electrolyte balance, and blood pressure in susceptible patients. The renal effects of these agents are directly related to their potency in inhibiting renal prostaglandins as reflected by inhibition of urinary prostaglandin excretion; however, none of the nonsteroidal anti-inflammatory drugs is completely free of the risk. Hyperkalemia is the most frequently observed adverse effect, most commonly occurring in patients with diabetes mellitus, patients with mild to moderate renal insufficiency, and patients receiving beta blockers, angiotensin converting enzyme inhibitors, or potassium-sparing agents. Patients at risk for the development of fluid retention and acute reductions in glomerular filtration rate include those with congestive heart failure, systemic lupus erythematosus, chronic glomerulonephritis, or liver failure with ascites, those receiving diuretics, premature infants, and possibly the elderly. Monitoring of serum creatinine and electrolyte levels, blood pressure, and body weight is suggested for susceptible patients receiving these agents.
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PMID:Implications of nonsteroidal anti-inflammatory drug therapy. 394 27

Long-acting nifedipine tablets were given to 47 severely and moderately hypertensive patients with renal insufficiency, cardiovascular, cerebrovascular, and peripheral vascular disease, diabetes mellitus, asthma, and systemic lupus erythematosus. Nifedipine substituted vasodilators (n = 22), was added to beta blockers and thiazides (n = 14), and was used alone (n = 11). In all three groups blood pressure was significantly reduced without aggravation of angina pectoris, intermittent claudication, cerebrovascular disease, or renal failure. Side effects were mild and transient. We found nifedipine tablets convenient and safe, as well as efficacious in patients with serious conditions.
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PMID:Long-acting nifedipine in moderate and severe hypertensive patients with serious concomitant diseases. 401 94

Medical records of patients having unilateral nephrectomies done between 1953 and 1978 at a university hospital were reviewed after 5 to 30 years of follow-up to determine if this procedure causes insidious renal insufficiency. Forty patients (selected from 571) ranging in age from 20 to 72 years met the following criteria for inclusion in the study: subject over 20 years of age at nephrectomy; initial serum creatinine concentration less than 1.6 mg/dL; normal arterial blood pressure (less than 150/90 mm Hg); absence of risk factors for chronic renal disease, eg, systemic lupus erythematosis, diabetes mellitus, chronic glomerulonephritis; an initial and a follow-up serum creatinine level; at least 5 years of follow-up. After a mean follow-up of 11.8 years, paired analysis of changes in serum creatinine concentrations showed insignificant differences between pre- and post-nephrectomy levels (0.19 +/- 0.11 mg/dL +/- SEM). Only one patient had a post-nephrectomy serum creatinine level above 2.0 mg/dL. Six patients (four women, two men) developed hypertension (15%) after uninephrectomy, an incidence of hypertension not greater than that found in the population at large. We conclude that uninephrectomy at ages older than 20 years does not lead to renal insufficiency or hypertension in adult patients with normal prenephrectomy serum creatinine and blood pressure levels.
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PMID:Long-term effect of uninephrectomy on serum creatinine concentration and arterial blood pressure. 403 59

Infusions of corticosteroids in massive doses (methylprednisolone 1 g/day for 1 to 3 days) are used by nephrologists against acute episodes of rejection of transplanted kidneys and in acute glomeruloneppritis , especially lupic , with threatening renal failure. During the last few years this method has been tried in collagen diseases, notably in acute episodes of systemic lupus erythematosus without renal insufficiency, in rheumatoid arthritis and in ankylosing spondylitis. Published controlled studies concerning these three diseases are too few for firm conclusions to be drawn. The improvement obtained during 3 months on average after 3 g (1 g/day for 3 days) is not observed in all patients and it is not certain that such high doses are innocuous: they do not seem to have been responsible for deaths, as reported in patients with renal transplantation, but undesirable side-effects are observed in one-half of the cases. Close supervision with repeated measurement of blood electrolytes and electrocardiograms is mandatory during and immediately after treatment.
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PMID:[Pulse corticoid therapy in rheumatology]. 623 85

To determine whether patients with systemic lupus erythematosus (SLE) and active nephritis have more profound defects in suppressor cell activity, we studied concanavalin A (Con A)-induced suppressor cell activity (SCA) in 12 patients with lupus nephritis (LN) and 11 patients with chronic mesangial proliferative glomerulonephritis (CGN) without renal insufficiency. The levels of Con A-induced SCA were decreased in patients with LN compared with those in normal controls and those in CGN patients and lower in LN patients with the nephrotic syndrome (NS) than in those without NS. In contrast, the mean responses of Con-A-induced SCA in CGN patients with or without NS did not differ from normal subjects. These findings may lend further insight into the understanding of the immunoregulatory defect in LN.
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PMID:Defective concanavalin A-induced suppressor cell activity in lupus nephritis. 623 93

To determine whether patients with systemic lupus erythematosus (SLE) and active nephritis have more profound defects in cellular immune responses, we studied cell-mediated immunity (CMI) in 12 patients with lupus nephritis (LN) and 11 patients with chronic mesangial proliferative glomerulonephritis (CGN) without renal insufficiency. The LN patients had a significant depression in CMI, characterized by impaired delayed hypersensitivity skin reactivity to keyhole limpet haemocyanin (KLH), decreased percentage of T cells and diminished lymphocyte transformation to phytohaemagglutinin (PHA). The levels of concanavalin A (Con A)-induced suppressor cell activity (SCA) were significantly lower in LN patients compared with those in normal controls and those in CGN patients. The levels of all CMI parameters for the 6 LN patients with the nephrotic syndrome (NS) were significantly more decreased when compared with those of the 6 LN patients without NS. In contrast, the CMI levels in CGN patients with or without NS did not differ from normal subjects. These findings may lend further insight into the understanding of the immunoregulatory defect in LN.
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PMID:Defective cellular immune responses in lupus nephritis. 648 92

Three cases are presented, in two of which the CNS lesions revealed the presence of systemic lupus erythematosus (SLE). The diagnosis of SLE was certain according to the criteria of the ARA, and it was further confirmed by results of renal needle puncture biopsy. Case 1: A 16-year-old adolescent developed choreic movements followed, one month later, by psychotic symptoms suggesting a mixed hebephrenic-catatonic schizophrenic affection. Cutaneous lesions and signs of renal insufficiency 3 months later established that these disorders were related to SLE. A favourable outcome was observed rapidly for the systemic signs, recovery from neuropsychic symptoms being obtained after 3 months only but then in a few days. This course suggests the diagnosis of a "functional psychosis" of lupus origin. Case 2: A 24-year-old woman developed left hemiparesis followed by febrile coma. The slowly favourable course of the disease led to the appearance of a progressive dementia, with numerous epileptic seizures. Although tests for antinuclear antibodies were negative and the ESR was normal, several minor biological anomalies were suggestive of a systemic disease and the diagnosis of SLE was finally established. Corticotherapy produced only slight transient improvement. This progression towards dementia with progressive cerebral atrophy is most probably related to cerebral lupus lesions, the initial coma in the absence of any other apparent cause possibly being the first sign. Case 3: A 47-year-old woman developed simultaneously or separately episodes of arthralgia and uveitis of unknown origin over a 12-year period, and attacks of regressive multilocular neurological deficiency over a 15-year period.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Central nervous system involvement in systemic lupus erythematosus]. 671 10

A young Black woman with mixed connective tissue disease (MCTD) developed an aseptic meningitis after receiving ibuprofen. The meningeal reaction, reported infrequently in systemic lupus erythematosus (SLE) and only once previously in MCTD, was characterized by a predominantly polymorphonuclear cerebrospinal fluid (CSF) pleocytosis and depression of CSF glucose. Reversible renal insufficiency also occurred. Features suggestive of a hypersensitivity reaction included pruritus, conjunctivitis, facial oedema, desquamation of the palms and soles, and subsequent near total alopecia. Meningeal signs responded rapidly to systemic corticosteroid therapy. Patients with MCTD as well as those with SLE may be at peculiar risk of developing this uncommon reaction to ibuprofen.
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PMID:Ibuprofen-induced meningitis in mixed connective tissue disease. 698 77

Focal proliferative lupus glomerulonephritis has traditionally been considered to be more benign than the diffuse form. A recent study of lupus nephritis using the W.H.O. classification demonstrated no difference in 4-year survival between those with focal and those with diffuse disease. Because of this development, a comparative clinicopathologic study of 15 patients with focal proliferative lupus glomerulonephritis was done using the W.H.O. classification. Generally, patients with focal proliferative lupus glomerulonephritis presented with milder renal disease with respect to proteinuria and renal insufficiency. Involvement of the central nervous system was more prominent in focal proliferative lupus glomerulonephritis. Therapy for both types of disease was similar. Mean duration of renal disease was 48 months for focal and 50.7 months for diffuse disease. Three patients with focal proliferative lupus glomerulonephritis and two with diffuse proliferative lupus glomerulonephritis were dead at the end of the follow-up period. Established renal failure was present in one patient with focal disease and two with diffuse disease. Deterioration of renal function was noted in two patients with focal proliferative lupus glomerulonephritis and five with diffuse proliferative lupus glomerulonephritis at the end of the follow-up period. No statistically significant differences in cumulative five-year survival rates (focal = 0.751; diffuse = 0.858), cumulative five-year renal survival rates (focal = 1.00; diffuse = 0.846), deterioration of renal function and quantitative proteinuria at the end of the follow-up period were noted. although qualitatively milder, the focal form of renal disease followed a course similar to that of the diffuse type.
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PMID:Focal proliferative lupus nephritis. A clinicopathologic study using the W.H.O. classification. 704 45


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