Showing posts with label Lupus Nephritis. Show all posts
Showing posts with label Lupus Nephritis. Show all posts

Thursday, May 14, 2015

Lupus Nephritis Need Not Prevent Renal Transplants

Kidney damage from lupus can be mild or severe. It can cause damage to the filtering units (glomeruli) of the kidney. Since these filtering units clear your blood of waste, damage to them can cause your kidneys to work poorly or not at all. About 90 percent of lupus patients will have some kidney damage, but only two to three percent actually develop kidney disease severe enough to require treatment.

Investigators reviewed outcomes from adults who had attended a lupus clinic at the Toronto Western Hospital in Toronto, Ontario, from 1970 to 2012. Among the 1,645 lupus patients treated in that interval, 25 had nephritis and underwent kidney transplantation. Most of these patients were white (40%) and African Canadian (28%). The remaining patients were Asian or members of other ethnic groups. None of them had any clinical evidence of lupus in the year before transplantation.

Two of the patients had a completely non-functional kidney post-transplant. Another four had graft failure, one within five years of transplant surgery and the remaining three after a longer period, with an average time to graft failure of 5.75 years. Of the 19 (76%) patients with graft survival, the graft survived at least five years in eight patients, with a mean graft survival among these eight patients of 5.7 years.

The four patients with graft failure and 19 with graft survival had roughly similar characteristics, except that the average age in the graft-survival group was higher (40 vs. 29.8 years). Significantly more whites and African-Canadians had graft survival than graft failure, at seven and one, and six and one, respectively.

In addition, the average time between lupus diagnosis and transplant was 15.5 year in the graft-survival group and 4.5 years in the graft-failure group. The respective average durations of dialysis prior to transplant were 5.8 and 3.9 years.

Three of the individuals in the graft-survival group died an average of 5.6 years post-transplant. The cause of death was not related to renal disease in two patients and unknown in the third. Another patient was lost to follow-up. In the graft-failure group, three patients died an average of six years post-transplant, and all the deaths were related to renal disease. The remaining patient is still living.

One (25%) of four patients in the graft-failure group had positive lupus serology a year before transplantation compared with nine (47%) of 19 patients in the graft-survival group. At one year post-transplant, the proportion of patients with lupus serology in the graft-failure group rose to 66%, while it fell to 42% in the other group.

“I presume that older patients had quiescent lupus disease activity for a longer period compared to the other patients, and it is possible that the severity of lupus disease activity tends to ameliorate [or] weaken years after the diagnosis of lupus,” said lead investigator Zahi Touma, MD, PhD, of the University of Toronto Lupus Clinic at the Toronto Western Hospital, in explaining the results.

In another poster presented at the rheumatology meeting, Dr. Touma and three other co-investigators analyzed the timeframe for either partial (at least 50% decrease from baseline in proteinuria) or complete, recovery from proteinuria in lupus nephritis patients. They determined that partial or complete recovery from proteinuria may be a better end point in clinical studies of this patient population because it tracks parallel to complete response but happens somewhat more quickly, which is an advantage in studies that do not last for decades. kidneyhospitalabroad@hotmail.com

Minorities, Uninsured Lack Care of ESRD in Lupus Nephritis

No one knows what causes the disease. Your family history and things in your environment such as infections, viruses, toxic chemicals or pollutants (car fumes, factory smoke) may play a role in causing the disease. Wherever immune complexes are deposited, immunofluorescence staining is positive for complement and for IgG, IgA, and IgM in varying proportions. Epithelial cells may proliferate, forming crescents. Classification of lupus nephritis is based on histologic findings

In the United States, minorities and those who lack private insurance are less likely to receive adequate care for end-stage renal disease (ESRD) due to lupus nephritis (LN), according to research published online Feb. 18 in Arthritis & Rheumatology.

Laura C. Plantinga, Sc.M., of Emory University in Atlanta, and colleagues analyzed data for 6,594 patients initiating treatment for LN-ESRD, from July 2005 through September 2011, to assess factors associated with quality of care.

The researchers found that, compared with white patients, black and Hispanic patients were less likely to receive pre-ESRD care (odds ratios [ORs], 0.73 and 0.72, respectively) and less likely to be placed on the waitlist for kidney transplant (hazard ratios [HRs], 0.78 and 0.82, respectively).

Compared with patients with private insurance, patients with Medicaid (HR, 0.51) or without insurance (HR, 0.36) were less likely to be placed on the waitlist. Only 24% of patients had a permanent vascular access, and uninsured patients were even less likely to have placement of vascular access (OR, 0.62).

"LN-ESRD patients have suboptimal ESRD care, particularly with regard to vascular access placement," the authors write. "Minority race/ethnicity and lack of private insurance were associated with inadequate ESRD care."

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Monday, May 11, 2015

Lupus Nephritis ESRD Rates Stable

Up to 60% of lupus patients will develop lupus nephritis. When the kidneys are inflamed, they can't function normally and can leak protein. Normally, the immune system helps protect the body from infection or harmful substances. But in patients with an autoimmune disease, the immune system cannot tell the difference between harmful substances and healthy ones. Every day, the two kidneys filter about 120 to 150 of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra fluid.

In a retrospective study using the U.S. Renal Data System database, investigators at the Chronic Disease Research Group of the Minneapolis Medical Research Foundation in Minneapolis, analyzed data from 1,557,117 individuals who initiated renal replacement therapy (RRT) from 1995–2010. Of these, 16,649 had ESRD from systemic lupus erythematosus (SLE).

The researchers, led by Robert N. Foley, MD, calculated standardized incidence ratios (SIRs) to 1995–1996, when the rate of SLE-related ESRD was 3.2 cases per million per year. Rates per million during 1995–1996 were higher for African Americans (11.1), female subjects (4.9), and individuals aged 20–29 (4.9), 30–44 (4.6), and 45–64 (4.0).

For the overall population, the SIRs of SLE-related ESRD requiring RRT were 1.19 in 1997–1998, 1.17 in 1999–2000, 1.17 in 2001–2002, 1.21 in 2003–2004, 1.18 in 2005–2006, 1.16 in 2007–2008, and 1.05 in 2009–2010, according to findings published online ahead of print in the Clinical Journal of the American Society of Nephrology.

During a median follow-up of 4.4 years, 42.6% of individuals with ESRD from SLE died, 45.3% were listed for renal transplantation, and 28.7% underwent transplantation.

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Compared with white patients, African-American patients were 23% more likely to die, after adjusting for age, sex, and other variables. Although African-American patients were 11% more likely that white patients to be listed for a renal transplant, they were 46% less likely to receive one.

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Friday, April 24, 2015

Lupus Nephritis Need Not Prevent Renal Transplants

With lupus, the body's immune system targets its own body tissues. Lupus nephritis happens when lupus involves the kidneys. General symptoms of lupus include malar rash, discoid rash, photosensitivity, oral ulcers, nonerosive arthritis, pleuropericarditis, renal disease, neurological manifestations, and haematological disorders. Up to 60 percent of people with SLE are diagnosed with lupus nephritis, which can lead to significant illness and even death.

Investigators reviewed outcomes from adults who had attended a lupus clinic at the Toronto Western Hospital in Toronto, Ontario, from 1970 to 2012. Among the 1,645 lupus patients treated in that interval, 25 had nephritis and underwent kidney transplantation. Most of these patients were white (40%) and African Canadian (28%). The remaining patients were Asian or members of other ethnic groups. None of them had any clinical evidence of lupus in the year before transplantation.

Two of the patients had a completely non-functional kidney post-transplant. Another four had graft failure, one within five years of transplant surgery and the remaining three after a longer period, with an average time to graft failure of 5.75 years. Of the 19 (76%) patients with graft survival, the graft survived at least five years in eight patients, with a mean graft survival among these eight patients of 5.7 years.

The four patients with graft failure and 19 with graft survival had roughly similar characteristics, except that the average age in the graft-survival group was higher (40 vs. 29.8 years). Significantly more whites and African-Canadians had graft survival than graft failure, at seven and one, and six and one, respectively.

In addition, the average time between lupus diagnosis and transplant was 15.5 year in the graft-survival group and 4.5 years in the graft-failure group. The respective average durations of dialysis prior to transplant were 5.8 and 3.9 years.

Three of the individuals in the graft-survival group died an average of 5.6 years post-transplant. The cause of death was not related to renal disease in two patients and unknown in the third. Another patient was lost to follow-up. In the graft-failure group, three patients died an average of six years post-transplant, and all the deaths were related to renal disease. The remaining patient is still living.

One (25%) of four patients in the graft-failure group had positive lupus serology a year before transplantation compared with nine (47%) of 19 patients in the graft-survival group. At one year post-transplant, the proportion of patients with lupus serology in the graft-failure group rose to 66%, while it fell to 42% in the other group.

“I presume that older patients had quiescent lupus disease activity for a longer period compared to the other patients, and it is possible that the severity of lupus disease activity tends to ameliorate [or] weaken years after the diagnosis of lupus,” said lead investigator Zahi Touma, MD, PhD, of the University of Toronto Lupus Clinic at the Toronto Western Hospital, in explaining the results.

In another poster presented at the rheumatology meeting, Dr. Touma and three other co-investigators analyzed the timeframe for either partial (at least 50% decrease from baseline in proteinuria) or complete, recovery from proteinuria in lupus nephritis patients. They determined that partial or complete recovery from proteinuria may be a better end point in clinical studies of this patient population because it tracks parallel to complete response but happens somewhat more quickly, which is an advantage in studies that do not last for decades.

This is our email kidneyhospitalabroad@hotmail.com. if you want know about more information, you can contact us online doctor. We will reply to within 24 hours.

Thursday, April 23, 2015

Mortality in Lupus Patients Does Not Differ By Dialysis Type

Lupus affects mainly the joints, kidneys and skin.  It can affect the skin, joints, kidneys, lungs, nervous system and other organs of the body. These symptoms vary over time in intensity and duration for each patient as well as from patient to patient. Many of these interventions can be modified for the hospitalized patient.

The mortality risk among patients with end-stage renal disease (ESRD) and lupus is similar regardless of their initial dialysis modality, according to a new study.

Gabriel Contreras, MD, of the University of Miami Miller School of Medicine, and colleagues used propensity score matching to create 1,352 matched pairs of patients with ESRD patients and systemic lupus erythematosus (SLE) who started hemodialysis (HD) or peritoneal dialysis (PD). The matched pairs were mostly women (86%) with a median age of 39 years. The median follow-up period was 3 years.

The HD and PD groups had overall mortality rates of 22.5% and 21.4%, respectively, within the first 3 years of observation, a non-significant difference between the groups, investigators reported online ahead of print in the Clinical Journal of the American Society of Nephrology. The matched pairs also had similar cardiovascular-related mortality rates (9.5% in the HD group, 10.5% in the PD group) and infection-related mortality (4.4% in the HD group and 3.0% in the PD group).kidneyhospitalabroad@hotmail.com.

Thursday, April 16, 2015

Mycophenolate Mofetil Have No Advantage in Lupus Nephritis

Lupus nephritis is an inflammation of the kidney caused by systemic lupus erythematosus (SLE). Also called lupus, SLE is an autoimmune disease. General symptoms of lupus include malar rash, discoid rash, photosensitivity, oral ulcers, nonerosive arthritis, pleuropericarditis, renal disease, neurological manifestations, and haematological disorders.

A 10-year follow-up of the MAINTAIN Nephritis trial showed no advantage of mycophenolate mofetil (MMF) over azathioprine (AZA) for lupus nephritis (LN) maintenance therapy.

The data confirm the relevance of recommendations from the European Renal Association-European Dialysis and Transplant Association and American College of Rheumatology regarding maintenance therapy of LN, namely that AZA and MMF can be prescribed, stated a research team led by Frédéric A. Houssiau, MD, professor of rheumatology at Universite catholique de Louvain, Brussels, Belgium.

The original MAINTAIN trial randomized 105 mostly Caucasian LN patients to maintenance MMF or AZA in 2002-2006. For the 10-year analysis, the investigators examined long-term outcomes, such as survival, kidney function, 24-hour proteinuria, and renal flares.

The researchers found that the time to renal flare did not differ between the AZA and MMF patients, according to results published online ahead of print in the Annals of Rheumatic Disease.

Furthermore, they discovered that patients with an early proteinuria decrease of 0.5g/day or less at 12 months have a very low risk of long-term renal impairment at 10 years. (Proteinuria greater than 0.5 g/day was not predictive of poor outcome, however.)

“At the bedside, the clinician can therefore confidently reassure patients who achieve a durable early response in proteinuria but should not consider a switch to an alternative agent based only on non-achievement of this target,” the researchers said.

Mycophenolate Mofetil have No Advantage in Lupus Nephritis And if you want to know more information about it, you can contact our online doctors, leave us messages or send email to kidneyhospitalabroad@hotmail.com, we will reply you within 24 hours.

Thursday, July 4, 2013

Treatment for Lupus Nephritis


Evaluating renal function in patients with SLE to detect any renal involvement early is important because early detection and treatment can significantly improve renal outcome. Renal biopsy should be considered in any patient with SLE who has clinical or laboratory evidence of active nephritis, especially upon the first episode of nephritis.

There are two factors can affect the prognosis of Lupus Nephritis. One is high blood pressure and the other is protein urine. High blood pressure can make the kidneys work harder. Over time, it can damage blood vessels throughout the whole body. The tiny blood vessels in kidneys are responsible for filtering blood. If the blood vessels are impaired, the filtering ability of kidneys will reduce significantly. To slow prognosis of Lupus Nephritis, controlling blood pressure within normal level( 130/80mmHg) can improve its prognosis.

Proteinuria has toxity, it can cause direct damage to glomerular mesangial cells and renal tubular, thus deteriorating renal function. Meanwhile, proteinuria can cause renal tubular anoxia, resulting in tubular impairment.

Corticosteroids, such as prednisone and prednisolone, are accepted as the initial treatment for lupus nephritis. The steroids may be given by mouth or intravenously. Also, high dose corticosteroids (methylprednisolone) that are given in single, large doses (pulses) intravenously for three consecutive days are also a useful initial treatment for lupus nephritis, which is then followed by corticosteroids by mouth. The immune suppression medications that are used to treat lupus nephritis include azathioprine (Imuran) and cyclophosphamide (Cytoxan), both of which can be given by mouth. These medicines may bring some side effects to the patients, so we usually suggest Chinese treatments for them. If you want to know more, you are welcomed to leave us a message or you can send us an email to doctornickzhnag@hotmail.com.

Monday, November 19, 2012

Immunotherapy treats Lupus Nephritis

Systemic lupus erythematosus is usually to be seen to affect the women in childbearing period, the male-female ratio is 1: (7-9.5). SLE is the systemic disease. Not only the kidneys also other organs can be damaged by SLE.

The clinical manifestations of Lupus Nephritis vary a lot. It could be asymptomatic proteinuria and/or blood in urine, high blood pressure, also Nephrotic Syndrome.

Proteinuria is the most common clinical manifestation of Lupus Nephritis, about 25% of patients present Nephrotic Syndrome. Microscopic hematuria is more common, compared to gross hematuria. Some patients can also have leucocyturia and cylindruria. The amount of leucocyturia and cylindruria can reflect the activity of the kidney lesions to some extent. A minority of Lupus Nephritis patients can have kidney tubules dysfunction, and present renal tubular acidosis and disturbance of potassium metabolism. 15%-50% of Lupus Nephritis patients have high blood pressure and impairment of kidney.

As to the treatment for Lupus Nephritis, we need to repair the damaged kidneys and rebuild the abnormal immune system of human body. Immunotherapy is the treatment we would like to recommend to Lupus Nephritis patients.

Blood purification techniques will be used to clean the blood, as there are much toxic substances in the blood. Please note that nearly all the Lupus Nephritis patients are treated by dialysis in many other countries. However, dialysis has its limitation, it can not eliminate the macromolecular toxins in the blood.

Chinese herbal medicine is used to repair the damaged kidneys and rebuild the immune system of human body. It can achieve the purpose which western medicine can not achieve. You can leave us a message to get more information about Immunotherapy.

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