Maintenance Dose Of Prednisone Research Articles

Relationship of renal transplantation to hypertension in end-stage renal failure

The relationship of renal transplantation to new onset or persistence of previously established hypertension was analyzed in 164 transplant recipients in whom the renal allograft functioned for six months or longer. Of the 164, thirty-seven (23%) had normal blood pressure and 127 (77%) were hypertensive prior to transplantation. Following transplantation 83 patients (51%) were normotensive; high blood pressure was found in 81 (49%). Posttransplant hypertension could not be correlated with the recipient's original renal disease, age, sex, renal donor source, donor age, or maintenance dose of prednisone. More normotensive paients had undergone prior binephrectomy when compared with the hypertensive group (P less than .05). Mean serum creatinine levels was higher (2.0 mg/dl) in hypertensives than in normotensives (1.54 mg/dl) (P greater than .05). Selective renal veins' renin measurements in patients with severe hypertension were not helpful in predicting the beneficial effects of either bilateral nephrectomy or surgical correction of transplant renal artery stenosis.

Long-Term Blood Pressure Changes in Renal Homotransplantation

Long-term blood pressure changes were studied in 50 patients who had undergone renal homotransplantation. Excluded were those subjects with arterial stenosis of the transplanted kidney, acute or rapidly progressive rejection, or recurrent glomerulonephritis, as well as those retaining their own diseased kidney(s). The blood pressure after the end of the first year was stable and, therefore, was utilized as the reference blood pressure for this study. One year after transplantation, hypertension was observed in 20% of the patients. Mean blood pressure was positively correlated with age (P less than .01), body weight (P less than .001), and serum creatinine level (P less than .001), and negatively correlated with maintenance dose of prednisone (P less than .01). A higher incidence of hypertension was observed in cadaver kidney transplantation than in living related-donor transplantation. The study minimizes the role of glucocorticoids and emphasizes the role of renal factors in the mechanism of the long-term blood pressure changes.

Immunosuppressants and prednisone in pemphigus vulgaris: therapeutic results obtained in 63 patients between 1961 and 1975

• Evaluation of the treatment in 63 patients with pemphigus vulgaris showed that six patients (9.5%) died of the consequences of high-dosage prednisone treatment, while 24 patients (38.1%) were free of lesions and not receiving treatment. Immunosuppressants (methotrexate, cyclophosphamide, and azathioprine) are of value in patients with severe pemphigus vulgaris since they often reduce the maintenance dose of prednisone required after high-dosage prednisone treatment. Immunosuppressants are of even greater value in patients in the early, stable stage of pemphigus vulgaris. Of 16 such patients initially treated with a combination of an immunosuppressant and maintenance doses of prednisone not exceeding 40 mg on alternate days, 13 at no time required treatment with higher doses of prednisone. The good results obtained with this method emphasize the importance of diagnosing and treating pemphigus vulgaris in its early stage. (<i>Arch Dermatol</i>113:1236-1241, 1977)

Immunosuppressants and Prednisone in Pemphigus Vulgaris

Evaluation of the treatment in 63 patients with pemphigus vulgaris showed that six patients (9.5%) died of the consequences of high-dosage prednisone treatment, while 24 patients (38.1%) were free of lesions and not receiving treatment. Immunosuppressants (methotrexate, cyclophosphamide, and azathioprine) are of value in patients with severe pemphigus vulgaris since they often reduce the maintenance dose of prednisone required after high-dosage prednisone treatment. Immunosuppressants are of even greater value in patients in the early, stable stage of pemphigus vulgaris. Of 16 such patients initially treated with a combination of an immunosuppressant and maintenance doses of prednisone not exceeding 40 mg on alternate days, 13 at no time required treatment with higher doses of prednisone. The good results obtained with this method emphasize the importance of diagnosing and treating pemphigus vulgaris in its early stage.

Extended experience in the long-term corticosteroid treatment of pulmonary sarcoidosis.

A 15-yr experience with symptomatic pulmonary parenchymal sarcoidosis treated with corticosteroids has included 250 patients. Within the past 5 yr 192 patients have been actively studied and these are reported in detail. Varied clinical observations are described. Serial measurements of vital capacity and steady-state carbon monoxide diffusing capacity were performed. All of these patients were sufficiently symptomatic and incapacitated to require treatment. Ninety-one percent were Black, 72% were female, and 72% were in the third and fourth decades. In response to treatment there was overall clinical improvement and an increase in vital capacity in 150 (83%) of 180 patients, although only a temporary increase in 12 of these patients. By contrast, only 82 (46%) showed an increase in carbon monoxide steady-state diffusing capacity and only temporarily in 19 patients. Changes in vital capacity correlate well with changes in symptoms and the radiographic appearance and are of great assistance in assessing the clinical course and need for continued treatment. The diffusing capacity is more difficult to interpret. Continued treatment was required in 74 patients (48%) because of recurrent clinical relapses as treatment was withdrawn. Such relapses were observed in 70% of the patients. Improvement and discontinuation of treatment was achieved in 66 patients (42%). In the 44 in whom there was no observed relapse, 34 were treated for less than 2.5 yr. In the total group, longer periods of treatment, 2.5-10 yr or more, were required in 104 patients (54%). In this series of 192 patients there were 7 deaths, with 22 deaths in the total 15-yr series of 250 patients. Of these, 18 were directly attributed to the sarcoidosis. Clinical improvement coincident with corticosteroid treatment and the frequency of relapse as treatment is withdrawn strongly support the benefits of corticosteroid treatment for symptomatic pulmonary sarcoidosis. When relapses occur and recur, retreatment is necessary and often long-term maintenance doses of prednisone (10-15 mg daily) are required for many years. The relatively infrequent problems related to this treatment are greatly exceeded by the clinical benefits.

Variations in arterial blood pressure after kidney transplantation. Relation to renal function, plasma renin activity, and the dose of prednisone.

The course of hypertension within the first 2 months after kidney transplantation was correlated with renal function, plasma renin activity (PRA), and the daily maintenance dose of prednisone in 18 homograft recipients. During acute rejection blood pressure (BP) closely correlated with PRA. Patients with normal homograft function showed an increase in BP early after transplantation which in most returned to normal 3-8 weeks later. In the latter group no correlation could be found between the level of BP and PRA, however the BP correlated closely with the dose of prednisone. These observations suggest that during acute rejection the increase in BP may at least partly be mediated by a renal pressor mechanism, whereas with normal renal function the high dose of glucocorticoids may play an important role in the development of hypertension.

Methotrexate and Prednisone in Pemphigus Vulgaris

Twenty-four of 36 patients with pemphigus vulgaris were treated with methotrexate alone or in various combinations with prednisone, All 24 patients were living and in good condition when reexamined on Sept 1, 1971. Eight patients were free of lesions, whereas 16 patients still had some lesions, predominantly in the mouth. It seems that in patients who receive a regimen of methotrexate in the early phase of the disease the need for, or length of, highdosage treatment with prednisone is reduced. In patients with advanced disease in whom the disease has been brought under control by high-dosage treatment with prednisone, smaller maintenance doses of prednisone usually are possible when methotrexate is also administered. Methotrexate therapy in weekly doses of 20 to 50 mg caused no serious complications. Oral lesions respond much less readily than cutaneous lesions to methotrexate.

Retrobulbar Lacrimal Gland: A Rare Anomaly and Control of an Unusual Complication

Attention has recently been called1 to the occurrence of this rare anomaly. Certain unusual features in our patient make its reporting worthwhile. In the eight previously reported cases of retrobulbar lacrimal gland evidence of successful treatment with retention of vision and absence of diplopia, is lacking. We believe our case fulfills these conditions. It was found necessary to use a small maintenance dose of prednisone to relieve the symptoms even though the primary pathologic process was a space occupying lesion of the orbit. A possible mechanism which might make an anti-inflammatory agent useful is postulated.

Treatment of Pemphigus Vulgaris With Methotrexate

Five patients with pemphigus vulgaris were treated with the immunosuppressive drug, methotrexate. Treatment was effective in three patients in whom the disease previously had been held in nearly complete remission by maintenance doses of prednisone. Also, good results were obtained in one patient who was in the very early stage of the disease. The toxicity of methotrexate limited, however, its usefulness in one patient with very active pemphigus vulgaris since very high doses appear to be necessary for an adequate control of the disease.

Prednisone alone and in combination with salicylates and phenylbutazone in the treatment of rheumatoid arthritis.

THE adrenal steroids have attained wide acceptance as therapeutic agents in the treatment of rheumatoid arthritis. The chemical analogue of cortisone, prednisone, has properties that have made the steroid approach even more useful in this field of therapy. Specifically, the retention of sodium and the excretion of potassium in unphysiologic amounts, found during cortisone administration, are avoided with the usual maintenance doses of prednisone.1 , 2 Prednisone can be used in cardiac patients without fear of producing or increasing congestive heart failure and in hypertensive patients when salt restriction is desirable. The hypertensive effect occasionally found with cortisone therapy has been shown . . .

Prednisone and prednisolone therapy in rheumatoid arthritis; clinical evaluation based on continuous observations for periods of six to nine months.

• The effects of prednisone, prednisolone, and hydrocortisone were compared in 141 arthritic patients over periods from six to nine months. None of the cases were mild, and the average duration had been 126 months. Administration of the drugs was discontinued in 12 instances because improvement was insignificant and/or serious complications intervened. Maintenance dosages were determined in the remaining patients. In the moderately severe cases, the maintenance doses of prednisone and prednisolone were found to be 5 to 15 mg. per day by mouth, indicating these drugs are about four times as potent as hydrocortisone. The two drugs, though of equal potency, differed in the variety of side-effects they induced. Gastric complaints, as well as gastric ulcers disclosed by roentgenography, developed in several patients. In choosing among the drugs now available for arthritis, it is possible and necessary to consider their varying effects on individuals.