Hypertrophic lupus vulgaris of 67 years' duration
Hypertrophic lupus vulgaris of 67 years' duration
复制标题
肥厚性寻常狼疮67年
DOI：
10.1111/j.1365-2133.1994.tb08478.x
复制
发表时间：
1994
影响因子：
10.3
通讯作者：
R. Naranio
中科院分区：
文献类型：
--
作者：
C. Goicoechea;P. Ruiz;E. Soler;María Abajo;J. Linares;J. Abad;R. Naranio
两名患者（1 号和 3 号）似乎已完全康复，4 号患者实际上也是如此。然而，与治疗前的肌酐和 CFR 值相比，2 号和 5 号患者的肾功能仍然存在显着损害。尽管自停用 CyA 以来已经有所改善。除了患者 2 和 5（肾功能恢复最差）之外，GFR 和血清肌酐作为肾功能测量值之间存在良好的相关性。两人的基线血清肌酐水平均正常，但相对于他们的年龄，基线 GFR 测量值相对较低。尽管对于患者 2 来说，这是在治疗 2-5 年之后。对于检测肾功能受损，GFR 是比血清肌酐更敏感的测试，因此患者 2 和 5 可能有一些预先存在的肾脏异常，这使他们容易出现 CyA 的肾毒性副作用。因此，治疗前 GFR 似乎是检测可能因 CyA 加重的轻度肾脏疾病的额外保障。如果无法获得，可能建议使用三个基线血清肌酐水平的平均值。血清肌酐持续升高的时间长度与随后的肾功能损害之间没有相关性。患者 1 和 4 的肌酐升高时间最长（分别为 20 个月和 3 年），但两人均表现出良好的恢复，恢复到基线测量值的 10% 以内。患者 2 和患者 5 恢复得最慢，两人的肌酐水平均在 15 个月内升高。这项研究（尽管承认涉及的人数很少）表明，在相对较长的治疗期后停用 CyA 时，肾功能确实有所改善，并且肾毒性没有进展。关于 CyA 后肾功能受损的可逆性的可用数据很少。 Korstanje ct fl/ 的一项研究。'报道了 8 名患者平均接受低剂量 CyA 治疗 12 个月（范围 4 -16 个月），并且在停药 4 个月后表现出持续的肾功能损害。这可能与初始CyA剂量（5 mg/kg）有关，此后肾功能仍可能改善。然而，在我们的五名患者中，有两名患者的肾功能仍然存在一定程度的受损，因此跟踪这些人以记录他们随后的病程非常重要。
In two patients (nos 1 and 3), recovery appears to be complete, and virtually so in patient 4, However, in patients 2 and 5, there is still significant impairment of renal function, compared with pretreatment values of creatinine and CFR. although improvement has taken place since discontinuing CyA. There was good correlation between GFR and serum creatinine as measurements of renal function, apart from patients 2 and 5 (who had the poorest recovery of renal function). Both had normal baseline serum creatinine levels, but relatively low baseline GFR measurements for their ages. although in patient 2 this was after 2-5 years of treatmenl. The GFR is a more sensitive test than serum creatinine for detecting impaired renal function, and it is therefore possible that patients 2 and 5 may have had some pre-existing renal abnormality which predisposed them to the nephrotoxic sideeffects of CyA. Therefore, a pretreatment GFR would appear to be an additional safeguard in detecting mild renal disease which may be aggravated by CyA. If this is not available, it is probably advisable to use the mean of three baseline serum creatinine levels. There was no correlation between the length of time the serum creatinine was persistently elevated and subsequent impairment of renal function. Patients 1 and 4 had the longest periods of elevation of creatinine (20 months and 3 years, respectively), but both showed good recovery to within 10% of baseline measurements. Patients 2 and 5. who had the least recovery, both had elevated creatinine levels for periods of 15 months. This study (although it is acknowledged that the numbers involved are small) shows that renal function does improve when CyA is discontinued after relatively long treatment periods, and that there is no progression ofthe nephrotoxicity. There are little available data on reversibility of impaired renai function after CyA. A study by Korstanje ct fl/.' reported eight patients who had received low-dose CyA for an average period of 12 months (range 4 -16 months), and who showed sustained renal impairment 4 months after withdrawal of CyA. This may have been related to the initial CyA dose (5 mg/kg), and renal function may still improve after this period. However, in two of our five patients there is still some degree of impaired renal function, and it will therefore be important to follow these individuals, to document their subsequent course.