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

A clinicopathologic autopsy study of the vascular changes in the kidneys of 100 patients with systemic lupus erythematosus was undertaken. Necrotizing arteritis was found in seven patients, mucinous intimal thickening in nine, onion-skin intimal thickening in two, and renal vein thrombosis in two. Active necrotizing arteritis was present most frequently in the arterioles and interlobular arteries, with healing necrotizing arteritis predominating in the arcuate and interlobar arteries. These events were closely related to the activity of glomerular lesions, and immunologic vascular injury seemed to be the causative factor. Rapidly progressive renal failure and severe hypertension had characterized the clinical courses of the patients. Mucinous intimal thickening, present in the arterioles and interlobular arteries, had been accompanied by accelerated hypertension. Although dialysis or accelerated hypertension may have been causes, other factors, including glucocorticoid therapy, must be considered. In one patient with class II lupus nephritis, renal vein thrombosis was considered the cause of the nephrotic syndrome. These vasculopathies, often detected in patients with lupus at autopsy, seem to alter the clinical course.
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PMID:Incidence and significance of intrarenal vasculopathies in patients with systemic lupus erythematosus. 397 86

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

Authors review their own experience in PAN, Lupus ery thematosus and renal Amyloidosis. Two patients with PAN, both with arterial hypertension: one of them of macrosco pic type, presenting great aneurysms localized in brain and in renal arteries; the other patient had microscopic type, with good response to corticotherapy after three years of follow-up. Four patients with lupus erythematosus nephritis; kidney biopsy was performed in three of them: two cases with membranoproliferative glomerulonephritis, and the last one with extramembranos glomerulonephritis. All of them had nephrotic syndrome, and arterial hypertension. Seven patients with renal amyloidosis, four related to reumatoid artritis, two related to mucoviscidosis and the las case was a patient with recurrent mediterranean fever.
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PMID:[Collagenosis nephropathies]. 611 54

In a randomized cross-over trial in 23 patients with essential hypertension, a new peripheral vasodilator, endralazine, in a dose of 10-20 mg t.i.d. was compared with dihydralazine in a dose of 25-50 mg t.i.d. All patients also received pindolol (a beta-blocker) in a dose of 5-15 mg t.i.d. The lowest dose of both drugs was given to all patients for 2 weeks and was increased only if indicated. Endralazine was more effective than dihydralazine, but the side effects were about the same in frequency and severity, apart from flushing, which was more common with endralazine. Patients receiving endralazine in the second phase of the cross-over design continued to be treated with endralazine for a period of 10-12 months. Blood pressure control remained good during this time, and the dosage was slightly reduced. No side effects suggestive of drug-induced lupus were seen, and only borderline changes in immunological tests [antinuclear antibodies (ANA)] in one patient were seen. One patient was reported to have lupus erythematosus (LE) cells in the peripheral blood but the ANA test was negative. Endralazine appears to be a useful new drug for the treatment of hypertension.
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PMID:Endralazine, a new peripheral vasodilator--a randomized cross-over trial against dihydralazine. 618 29

Renal involvement is uncommon in the hydralazine induced systemic lupus erythematosus syndrome. Six women with hypertension are described who developed an immune complex glomerulonephritis after taking 50-300 mg hydralazine daily for 6 months to 7 years. Associated features were anemia (100%), hypocomplementemia (50%), a positive antinuclear antibody test (100%) and antibodies to double-stranded DNA (66%). All patients were slow acetylators and four had HLA-DR 4 genotype. Renal function deteriorated in all cases. Cessation of hydralazine combined with immunosuppressive therapy resulted in amelioration of the disease. It is likely that the patients had a hydralazine induced lupus glomerulonephritis, or alternatively had an unmasking of an inherent tendency to idiopathic lupus nephritis by hydralazine.
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PMID:Hydralazine and lupus nephritis. 624 Mar 59

Lupus-prone (NZB X NZW)F1 (B X W) mice and MRL-lpr and BXSB mice were examined for the prevalence of hypertension and levels of plasma renin activity (PRA). Hypertension (greater than 145 mmHg) was observed only in female and male B X W mice with severe nephritis; in female MRL-lpr and male BXSB mice severe nephritis developed without blood pressure elevation (80-135 mmHg). The B X W parental strains, NZB and NZW, and the MRL-lpr congenic partners, MRL- +, did not become hypertensive as they aged. Other strains of mice, aged 3-32 months (A/HeN, BALB/cJ, BALB/cByJ, B10.S/Sg, B10.D2/ oSn , CBA/J, C3H/HeJ, SJL/J and [SJL X NZW]F1), also had normal blood pressure (98-122 mmHg). All mice with lupus nephritis had low PRA, even those with hypertension; furthermore, the MRL-lpr strain had low or undetectable PRA (2 +/- 1 ng/ml/hr), even when kidneys were normal. NZB, NZW, and MRL- + mice had normal PRA (10-16 ng/ml/hr). Thus, B X W mice frequently developed low renin hypertension during the last phase of their renal disease; whereas MRL-lpr and BXSB mice died from renal disease without observable increases in blood pressure.
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PMID:Differences in the occurrence of hypertension among (NZB X NZW)F1, MRL-lpr, and BXSB mice with lupus nephritis. 637 6

The true incidence of the lupus syndrome induced by hydralazine was determined in a longitudinal study of 281 patients consecutively starting hydralazine for hypertension over a 51 month period. Data on the duration of treatment and the maximum dose achieved were examined using life table analysis. After three years' treatment with hydralazine the incidence of the lupus syndrome was 6.7% (95% confidence limits 3.2-10.2%). The incidence was dose dependent, with no cases recorded in patients taking 50 mg daily and incidences of 5.4% with 100 mg daily and of 10.4% with 200 mg daily. The incidence was higher in women (11.6%) than in men (2.8%). In women taking 200 mg daily the three year incidence was 19.4%. Hydralazine is an effective antihypertensive drug that has come to be used in restricted dosage (not more than 200 mg daily) because of its risk of inducing the lupus syndrome. This study shows that the true incidence of the syndrome is still unacceptably high even when the drug is prescribed according to current recommendations.
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PMID:The lupus syndrome induced by hydralazine: a common complication with low dose treatment. 643 20

A patient with a circulating lupus anticoagulant in the absence of systemic lupus erythematosus developed recurrent deep venous thromboses and pulmonary emboli. Pulmonary emboli recurred despite prolonged oral anticoagulant therapy and resulted in fatal pulmonary arterial hypertension. Extended anticoagulant therapy alone may not prevent recurrent thromboembolism in patients with a lupus anticoagulant. Pulmonary thromboembolism may be an important factor in the pathogenesis of pulmonary hypertension in patients with a lupus anticoagulant.
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PMID:The lupus anticoagulant, pulmonary thromboembolism, and fatal pulmonary hypertension. 643 49

Endralazine, a new peripheral vasodilator, was studied in 21 patients with hypertension and chronic renal failure. Nineteen patients had unacceptable control of hypertension with their previous therapy, and 2 were suffering adverse effects for other third line drugs. All patients continued to receive a beta-adrenergic blocking agent. Five patients failed to complete the study, two because of poor compliance, and 3 as a result of failure to control raised blood pressure. In the remaining 16 patients, satisfactory blood pressure reduction was seen at 6 months and was maintained in 12 patients followed for 18 months. Endralazine was well tolerated. No patient developed the lupus syndrome nor evidence of drug-induced immunological abnormality.
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PMID:Long-term effects of endralazine (BQ-22-708) in patients with renal impairment and hypertension. 664 4

In the treatment of severe hypertension the choice of vasodilator is limited by side-effects, of which the lupus erythematosus syndrome induced by hydralazine is potentially the most serious, particularly in patients with the slow acetylator phenotype. This study describes the clinical evaluation of a new vasodilator, endralazine, which is related to hydralazine but which is not metabolised to any great extent by acetylation. In 6 essential hypertensives not adequately controlled by combined beta-blocker and diuretic therapy the additional administration of the first dose of 10 mg endralazine resulted in a significant reduction in blood pressure, without orthostatic symptoms, but associated with significant increases in heart rate and plasma noradrenaline concentration. These 6 patients and a further 9 similar hypertensive patients were then prescribed twice daily endralazine for 4 weeks with significant improvement in blood pressure control. During this short period of maintenance treatment with endralazine the single dose observations were repeated and no significant changes in heart rate or plasma noradrenaline concentration were observed. In summary, endralazine is an effective vasodilator/antihypertensive which was well tolerated in a triple therapy regimen in this study.
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PMID:Clinical evaluation of endralazine (BO22708), a new vasodilator, in essential hypertension. 674 47


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