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Query: UMLS:C0409974 (lupus)
 22,386 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The course of systemic lupus erythematosus (SLE) in 34 patients receiving prednisone and immunosuppressive (cytotoxic) drugs is described. 31 patients are in continuous ambulatory care, 27 of them 3 to 17 years. Only two were hospitalized for therapeutic purposes: one patient because of exacerbation of lung tuberculosis; the second patient, who discontinued prednisone therapy despite active SLE, because of severe autoimmune haemolytic anaemia. The retrospective analysis of symptoms demonstrated that only 22 of the 31 patients manifested 4 or more of the prelimievious reports. Two patients with severe lupus glomerulonephritis and azotaemia at the time of initial evaluation did not benefit from combined therapy. Nine patients with mesangial and focal glomerulonephritis have normal kidney function up to 12 years after diagnosis (in two cases kidney function improved after therapy).
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PMID:[Classification and immunosuppressive therapy of systemic lupus erythematosus: long-term follow-up of 31 patients (author's transl)]. 120 30

Direct cutaneous immunofluorescence microscopical examination of uninvolved skin is an important diagnostic test in systemic lupus erythematosus. Its prognostic significance is undetermined. In twenty-four patients there was an increased incidence of leukopenia, hypocomplementaemia, and LE cells in patients with positive skin immunofluorescence. Positive cutaneous immunofluorescence of uninvolved skin was correlated with the most severe forms of lupus renal disease, membranous glomerulonephritis, and diffuse proliferative glomerulonephritis.
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PMID:The significance of a positive cutaneous immunofluorescence test in systemic lupus erythematosus. 120 77

Blastic transformation of peripheral blood lymphocytes following stimulation with phytohemagglutinin during immunosuppressive therapy (prednisone 2 mg/kg body weight, indomethacin 2--3-5 mg/kg, azathioprine 2--4 mg/kg, cyclophosphamide 1-5--3 mg/kg per day) was studied in 59 patients with various morpholigic forms of chronic glomerulonephritis and in 7 with lupus erythematosus nephritis. No uniformly regular influence of immunosuppressive therapy in the doses employed in glomerulonephritis on blastic transformation in in vitro cultures was noted. The specific drug administered was not decisive for the character of the change in reactivity of lymphocytes (increase or decrease in blastic transformation). The interesting observation was made that efficacy of treatment was high in patients with lowest initial values of blastic transformation and its greatest increase during therapy. Apparently, disorders of cellular immunity assessed on the basis of blastic transformation of lymphocytes stimulated with phytohemagglutinin are not a decisive prognostic factor in glomerulonephritis. The results are discussed from the aspect of a possible influence of immunosuppressive therapy on restoration of the physiological proportion of T and B lymphocytes in peripheral blood.
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PMID:Blastic transformation of lymphocytes in in vitro cultures during immunosuppressive therapy in patients with glomerulonephritis. 121 64

The time course of DNA binding capacity (DNA-bc) was found to correlate with the clinical course in a group of 21 patients who had biopsy-proven lupus glomerulonephritis and were treated with immunosuppressive agents. Eight patients showed a sequential DNA-bc pattern in which a high titre of anti-DNA antibody was present for a prolonged period of time all having an unfavourable clinical course. Persistently high values of DNA-bc preceded by as much as 10 months evidence of renal deterioration obtained by conventional renal function tests. Thirteen patients showed a low titre of anti-DNA antibody throughout most of their course, 12 having a favourable outcome. An initially high value of DNA-bc had no prognostic significance. These results suggest that the persistence of a high titre of anti-DNA antibody in patients with lupus glomerulonephritis is a poor prognostic sign.
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PMID:Prognostic significance of DNA-binding capacity patterns in patients with lupus nephritis. 122 25

Sera from patients with various types of glomerulonephritis (GN) as well as sera from rabbits with acute serum sickness were studied for the presence of circulating immune complexes (IC). The method used is based on the observation that IC inhibit the uptake of IgG aggregates by guinea-pig peritoneal macrophages. Inhibition significantly greater than with normal human sera was found with sera of patients with membranous GN, membranoproliferative GN, focal glomerular sclerosis, minimal change nephrotic syndrome, acute septicaemic glomerular diseases and systemic lupus erythematous. IC were also detected in rabbits with acute serum sickness during the period of immune elimination.
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PMID:Detection of circulating soluble immune complexes in patients with various renal diseases. 124 61

To investigate the role of thromboxane A2 (TxA2) in murine lupus, we assessed the effects of the specific thromboxane receptor antagonist GR32191 on immune complex glomerulonephritis in MRL-lpr/lpr mice. Forty mg/kg/day GR32191 was given by twice daily subcutaneous injection for eight weeks beginning at 12 weeks of age. This dose completely blocked the renal vasoconstriction produced by the thromboxane agonist U46619. After eight weeks of treatment, both glomerular filtration rate (GFR) (8.9 +/- 0.6 vs. 6.8 +/- 1.1 ml/min/kg; P less than 0.05) and PAH clearance (CPAH) (37.4 +/- 2.5 vs. 29.9 +/- 3.3 ml/min/kg; P less than 0.05) were significantly higher in mice given GR32191 compared to vehicle treated animals. Administration of GR32191 also reduced proteinuria from 18.1 +/- 11.6 to 3.7 +/- 1.3 mg/24 hours (P less than 0.05). In GR32191 treated MRL-lpr/lpr mice, renal hemodynamic function and proteinuria were not significantly different from congenic MRL-+/+ controls. Thromboxane receptor blockade had striking affects on renal histomorphology reducing both hyaline thrombi in glomeruli (P = 0.022) and interstitial inflammation (P = 0.006). Glomerular crescents and severity of vasculitis also tended to be reduced in mice receiving the thromboxane receptor antagonist. The overall histopathologic score in mice given GR32191 was significantly lower than vehicle treated animals (4.7 +/- 0.5 vs. 8.4 +/- 1.5; P = 0.016). These effects of GR32191 were associated with decreased excretion of thromboxane B2 (TxB2) in urine (292 +/- 37 vs. 747 +/- 155 pg/24 hr; P less than 0.005) as well as a modest reduction in glomerular deposits of IgG (semiquantitative score 2.6 +/- 0.2 vs. 3.5 +/- 0.2; P less than 0.02). Thus, chronic thromboxane receptor blockade markedly altered the course of renal disease in MRL-lpr/lpr mice, suggesting that TxA2 is an important mediator of renal dysfunction and injury in this murine model of lupus nephritis.
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PMID:Thromboxane receptor blockade reduces renal injury in murine lupus nephritis. 138 35

Estrogen is known to influence immune responses in healthy subjects in a dichotomous fashion. Thus, in number of previous studies we and others have demonstrated that B cell activities are augmented after exposure to estrogen whereas T cell reactivity is suppressed. Furthermore, it has been shown that this hormone has significant impact on the course of certain human and experimental autoimmune diseases. In this study we report that treatment with physiological doses of estradiol exerts dichotomous effects on different manifestations of the lupus disease in MRL/l mice. On one hand immune complex-mediated glomerulonephritis was significantly accelerated. This outcome was due to polyclonal B cell activation with increased production of antibodies to double-stranded DNA and formation of circulating immune complexes. In contrast, T cell-mediated lesions such as focal sialadenitis, renal vasculitis, and periarticular inflammation were all significantly ameliorated in MRL/l mice exposed to estrogen. Thus, we were able to demonstrate that, within one subject and even within one organ, administration of estrogen leads to differential outcome of SLE morbidity. We propose that the differential effect of estrogen on the manifestations of the autoimmune disease of MRL/l mice is due to its dichotomous effects on B and T cell-mediated immune responses.
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PMID:Estrogen accelerates immune complex glomerulonephritis but ameliorates T cell-mediated vasculitis and sialadenitis in autoimmune MRL lpr/lpr mice. 139 37

The principal value of the renal biopsy in patients with SLE is as a therapeutic guide. Although semiquantitative indices of nephron loss (chronicity = CI) and acute potentially reversible inflammation (activity = AI) are reported by some to have separate values from traditional classifications of glomerular pathology as predictors of outcome and therapeutic guides, this point remains controversial. We have tested the predictive value of the AI and CI in a large group of patients with severe lupus glomerulonephritis (SLE GN) and a mean follow-up of 281 weeks +/- 116 (mean +/- SD). A total of 86 patients entered into the study of plasmapheresis in severe SLE GN by the Lupus Nephritis Collaborative Study Group, and long-term follow-up was available in 83. The predictive value of the AI and the CI was described over the entire range of cut-off points by the method of receiver operator characteristics (ROC). ROC analysis demonstrated that there was no level of either AI or CI that predicted the outcome of death or renal failure with sufficient sensitivity and specificity to be useful in the individual patient. The CI signifies renal damage and nephron loss, whereas the AI describes potentially reversible pathology. Neither the CI nor the AI taken by itself predicts individual outcomes of renal failure or death in patients with aggressively treated SLE GN. Since the indices fail to identify the patient whose disease will progress to renal failure, they are both insufficient as therapeutic guides and add little to the management of the patient with severe SLE GN.
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PMID:Role of pathology indices in the management of severe lupus glomerulonephritis. Lupus Nephritis Collaborative Study Group. 140 52

A case of aggressive lupus nephritis in a pediatric renal transplant patient is described. She initially presented with end-stage glomerulonephritis for which an underlying etiology could not be determined. Ten months after cadaveric renal transplantation, systemic lupus erythematosus was diagnosed, when she developed diffuse proliferative glomerulonephritis in association with antinuclear antibody, anti-double-stranded DNA antibody and extrarenal manifestations of lupus. It is plausible that she developed recurrent rather than de novo lupus nephritis following transplantation. Reactivation of lupus nephritis in a renal transplant is unusual in adults, and is previously unreported in children.
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PMID:Lupus nephritis in a pediatric renal transplant recipient. 145 30

Little information is available about the clinical status and outcome of patients with a long history of lupus nephritis. We have reviewed the dossiers of 25 patients (23 women and two men) who have been monitored by our Unit for more than 10 years after the diagnosis of lupus nephritis. At presentation the mean age was 28.5 +/- 10.33 (SD) years, the mean plasma creatinine was 136.1 +/- 144.7 (SD) nmol/l, the mean proteinuria was 3.02 +/- 2.7 (SD) g/day. At initial renal biopsy 18 patients showed diffuse proliferative glomerulonephritis, six patients showed membranous glomerulonephritis and one showed focal proliferative glomerulonephritis. All patients but one were treated with corticosteroids and 18 were also given immunosuppressive agents. At the last observation (16 +/- 4.6 (SD) years after presentation), 19 patients have normal plasma creatinine (11 of them show proteinuria less than 0.2 g/day) and six patients show increased plasma creatinine (mean 203.3 +/- 61.9 (SD) mmol/l). Eleven patients have been without any treatment for 88 +/- 64 (SD) months. The incidence of lupus flare-ups fell significantly after the tenth year (0.31/patient/year between 0 and 10 versus 0.11 between years 11 and 27; p = 0.01). No case of pericarditis or cerebritis occurred after the tenth year. Only one case of cerebral thrombosis occurred before the tenth year, but ten severe atherosclerotic cardiovascular and cerebrovascular complications were seen after the tenth year (two cardiac infarcts, three angina pectoris, four cerebral thrombosis, one cerebral haemorrhage). Two cases of cancer (thyroid and lung) occurred after the tenth year. The professional rehabilitation was good in most patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Clinical status of patients after 10 years of lupus nephritis. 148 Jul 42


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