IMMUNOSUPPRESSIVE DRUG THERAPY IN LUPUS GLOMERULONEPHRITIS

狼疮性肾小球肾炎的免疫抑制药物治疗

• 批准号: 3754529
• 负责人: J E BALOW
• 金额: --
• 依托单位: NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/3754529
• 关键词: artificial immunosuppression; biopsy; chemoprevention; child (0-11); cyclophosphamide; drug administration rate /duration; drug adverse effect; glomerulonephritis; hormone therapy; human subject; human therapy evaluation; human tissue; immunopathology chemotherapy; immunosuppressive; kidney disorder chemotherapy; kidney function; longitudinal human study; methylprednisolone; prednisone; prognosis; renal failure; systemic lupus erythematosus

Pulse cyclophosphamide is more effective than prednisone alone in preventing renal failure in lupus nephritis. This study sought to define whether pulse methylprednisolone could equal pulse cyclophosphamide in preserving renal function, and whether there was a difference between long and short courses of pulse cyclophosphamide in preventing exacerbations of lupus. Patients were treated with prednisone and randomized to receive concomitantly (a) pulse methylprednisolone monthly for 6 months, or (b) pulse cyclophosphamide monthly for 6 months, or (c) pulse cyclophosphamide monthly for 6 months followed by a maintenance regimen every 3 months for an additional two years. Patients treated with pulse methylprednisolone had a higher probability of developing renal insufficiency than patients treated with the long course of pulse cyclophosphamide. In addition, patients treated with only a short course of pulse cyclophosphamide had a higher probability of major exacerbations of lupus than those treated with the extended course of pulse cyclophosphamide. Studies of ovarian toxicity in patients treated with pulse cyclophosphamide showed that risk is affected by both age at treatment and total doses of cyclophosphamide. A series of clinical and pathologic factors were analyzed for their ability to predict renal failure subsequent to entry into the therapeutic trials. Black race, age >30 years, anemia, elevated serum creatinine and hypocomplementemia significantly predicated adverse renal outcomes. However, renal biopsy features contributed additional prognostic information and significantly enhanced the strongest clinical model.

环磷酰胺冲击治疗比单用强的松治疗更有效， 狼疮性肾炎的早期症状有哪些 这项研究试图定义 甲基强的松龙冲击是否等同于环磷酰胺冲击 保留肾功能，以及是否有差异， 脉长短 环磷酰胺预防狼疮恶化。 患者 接受泼尼松治疗并随机接受伴随治疗（a）脉冲 甲基强的松龙每月一次，持续6个月，或（B）环磷酰胺脉冲 每月一次，持续6个月，或（c）每月一次环磷酰胺脉冲，持续6个月 随后每3个月进行一次维持治疗， 年 接受甲基强的松龙冲击治疗的患者 发生肾功能不全的概率高于接受 长期的环磷酰胺冲击治疗 此外，接受治疗的患者 只有一个短期的脉冲环磷酰胺有较高的 狼疮主要恶化的概率比那些用 延长脉冲环磷酰胺疗程。 卵巢毒性研究 在接受环磷酰胺冲击治疗的患者中， 受治疗时年龄和环磷酰胺总剂量的影响。 分析了一系列的临床和病理因素， 进入治疗后预测肾衰竭的能力 审判 黑人，年龄>30岁，贫血，血清肌酐升高， 低补体血症显著预测不良肾脏结局。 然而，肾活检特征有助于额外的预后 信息，并显着增强了最强的临床模型。