Abstract
ABSTRACTObjective To evaluate the therapeutic response to induction treatment in lupus nephritis patients.Methods A total of 29 patients diagnosed with systemic lupus erythematosus and biopsy-proven nephritis were divided into two groups, one with hypertensive individuals and another non-hypertensive patients. The hypertensive patients included were on drugs with antiproteinuric effect. The induction treatment comprised mycophenolate mofetil or cyclophosphamide, based on 24-hour proteinuria and serum creatinine parameters for therapeutic evaluation after 6 months of intervention. The retrospective evaluation of the follow-up was made based on information collected from the medical records.Results Patients with and without hypertension presented similar behaviors of proteinuria (p=0.127) and creatinine (p=0.514) over time. For proteinuria, only the time effect (p=0.007), but not hypertensive effect (p=0.232), was found. There was a reduction in proteinuria levels (reduction by 3.28g/24 hours, on average) from the beginning to the final measurement. As to creatinine, no hypertensive (p=0.757) or time (p=0.154) effects were found.Conclusion Similarity in behavior of proteinuria was observed, after induction treatment for nephritis, taking into account the hypertensive effect. The prior condition did not hinder these patients reaching the recommended proteinuria goal.
Highlights
In systemic lupus erythematous (SLE), kidney involvement has extreme impact on survival and quality of life of patients.[1,2]Most patients with lupus nephritis (LN) have immune complex-mediated glomerular disease, often associated with tubulointerstitial changes
The importance of renal involvement is evident since approximately 10% to 30% of individuals with LN progress to established chronic kidney disease (CKD), requiring renal replacement therapy, which leads to increased morbidity and mortality.[4]
According to the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR), it is recommended that kidney biopsy be carried out whenever there is a sign of renal involvement, especially proteinuria ≥0.5g/24 hours with glomerular dysmorphic hematuria and/or casts.(6.7)
Summary
In systemic lupus erythematous (SLE), kidney involvement has extreme impact on survival and quality of life of patients.[1,2]Most patients with lupus nephritis (LN) have immune complex-mediated glomerular disease, often associated with tubulointerstitial changes. According to the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR), it is recommended that kidney biopsy be carried out whenever there is a sign of renal involvement, especially proteinuria ≥0.5g/24 hours with glomerular dysmorphic hematuria and/or casts.(6.7). The severity of this disease varies, depending on the location of the immune complex deposit and quality of autoantibodies. The treatment of LN is an emergency among the proliferative forms, considering the risk of progression to CKD.[4] Lupus nephritis is initially treated with steroids, used in conjunction with other immunosuppressants in induction therapy, such as mycophenolate mofetil (MMF) and cyclophosphamide (CP). Calcineurin inhibitors or rituximab are recommended as complementary alternative options in LN.[4,10]
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