ANALYSIS OF DISEASE ACTIVITY INDICATORS IN PATIENTS WITH LUPUS NEPHRITIS BEFORE AND AFTER PULSES OF CYCLOPHOSPHAMIDE
Keywords:
lupus nephritis, cyclophosphamide, activity indicatorsAbstract
Introduction
Cyclophosphamide is currently one of the main cytotoxic drugs for the treatment of lupus nephropathy, a clinical manifestation of great morbidity and mortality.
objective
To evaluate 24-hour proteinuria levels in patients with Systemic Lupus Erythematosus, treated with pulses of cyclophosphamide, establishing a correlation with hemoglobin, erythrocyte sedimentation rate, creatinine and C3 and C4 complement fractions.
Methods
The medical records of 29 patients were analyzed before and after six consecutive monthly pulses of cyclophosphamide, correlating the levels of 24-hour proteinuria, hemoglobin, erythrocyte sedimentation rate, creatinine, C3 and C4.
Results
A decrease in 24-hour proteinuria (p<0.01), an increase in hemoglobin (p < 0.01), a decrease in erythrocyte sedimentation rate (p < 0.05) and an increase in C3 levels (p<0.01) were observed. .05) and C4 (p<0.05). A correlation was also found between hemoglobin and erythrocyte sedimentation rate (p<0.01), hemoglobin and C4 (p<0.05) and C3 and C4 (p<0.0l).
Conclusion
The analyzed and correlated parameters showed significant improvement, being more pronounced in proteinuria and hemoglobin. This retrospective study demonstrated the action of cyclophosphamide on indicators of disease activity in Systemic Lupus Erythematosus, and the correlation of these indicators.
Downloads
References
Appel GB, Cohen DJ, Pirani CL, Meltzer JI, _Estes D. Long-term follow-up ofpatients with lupus nephritis: a study based on the classification of the world health organization. Am J Med 1987; 83:877-85.
Austin HA, Balow JE. Treatment of lupus nephritis. Semin Nephrol 2000;20(3):265-76
Boumpas D T, Austin HA, Vaughn EM, et al. Controlled trial of pulse methylprednisolone versus two regimens of pulse cyclophosphamide in severe lupus nephritis. Lancet 1992; 3409(8822): 741-45.
Cabral AR, Alarcon - Segovia D. Autoantibodies in systemic lupus erythematosus. Curr Opin Rheumatol 1998; 10:409-16.
Calm TM, Li FK, Tang CS, et al. Efficacy of mycophenolate mofetil in patients with diffuse proliferative lupus nephritis. N Engl J Med 2000; 3430 6): 1156-62.
Chan AY, Hooi LS. Outcome of 85 lupus nephritis patients treated with intravenous cyclophosphamide: a single centre 10 year experience Med J Malaysia 2001;-55(1):14
Cheigh JS, Stenzel KH, Rubin AL, Chami J, Sullivan JF. Systemic lupus erythematosus in patients with chronic renal failure. Am J Med 1983; 75: 602-6.
Dooley MA, Cosio FG, Nachman PH, et al. Mycophenolate mofetil therapy in lupus nephritis: clinical observations. J Am Soc Nephrol 1999; 10(4): 833-9.
Dostal C, Tesar V, Rychlik I, et al. Effect of 1 year cyclosporine A treatment on the activity and renal involvement ofsystemic lupus erythematosus: a pilot study. Lupus 1998; 7(1):29-
Ginzler EM. Clinical trials in lupus nephritis. Curr Rheumatol Rep 2001; 3(3): 199-204.
Gladman D, Urowitz, MB. Systemic Lupus Erythematosus: clinical features. In: Klippel, JH, Dieppe, PA. Editors. Rheumatology, 2nd ed, Mosby; 1998. sec 7, 1. 1- 1. 18.
Gladman DD, Goldsmith CH, UrowitzMB, etal. Cross-cultural validation of three disease activity indices in systemic lupus erythematosus. J Rheumatol 1992; 19•.608-11.
Gladman DD, Goldsmith CH, Urowitz MB, et al. Sensitivity to change of 3 systemic lupus erythematosus disease activity indices: international validation. J Rheumatol 1994; 21 : 1468-71.
Glicklich D, Acharya A. Mycophenolate mofetil therapy for lupus nephritis refractory to intravenous cyclophosphamide. Am J Kidney Dis 1998; 32(2): 318-22.
Halers VM. Systemic Lupus Erythematosus: the complement system. In: Klippel JH, Dieppe PA, Editors. Rheumatology. 2nd ed. Mosby, 1998. sec 7, 4. 1-4.8.
Haubtz M, Schellong S, Gobel U, et al. Intravenous pulse administration of cyclophosphamide versus daily oral treatment in patients with antineutrophil cytoplasmic antibody- associated vasculitis and renal involvement: a propective, randomized study. Arthritis Rheum 998;41(10):183-544.
HorakP, Scudla V, Hermanovo Z, Pospisil Z, Faltynek L, Budikova M. Clinical utility of selected disease activity markers in patients with lupus erythematosus. Clin Rheumatol 2001; 20(5):33
Illei GG, Austin HA, Crane M, et al. Combination therapy with pulse cyclophosphamide plus pulse methylprednisolone improves long-term renal outcome without adding toxicity in patients with lupus nephritis. Ann Intern Med 2001; 135(4):248-57.
Isenberg DA, Shortall E, Newman S. Systemic lupus erythematosus: disease activity, severity, treatment and costs. J Rheumatol 1994; 21 (3):394-96.
Isenberg DA, Gordon C. From BILAG to BLIPS-disease activity assessment in lupus past, pre future. Lupus 2000; 9(9): 651-54.
Klippel JH. Indications for, and use of, cytotoxic agents in SLE. Baillieres ClinRheumatol 1998; 12(3): 511-27.
Korbet SM, Lewis EJ, Schwartz MM, Reichlin M, Evans J, Rohde RD. Factors predictive ofoutcome in severe lupus nephritis. Am J Kidney Dis 2000; 35(5):904-14.
Laitman R S, Glicklich D, Sablay LB, GrayzelAI, Barland P, Bank N. Effect of long-term normalization of serum complement levels on the course of lupus nephritis. Am J Med 1989; 87:132-38.
Le Blanc B, Gladman DD, Urowitz MB. Serologically active clinically quiescent systemic lupus erythematosus: predictors of clinical flares. J Rheumatol 1994; 21(12):2239-41.
Levin J. Estatística aplicada a ciências humanas. São Paulo: Harper & Row do Brasil; 1978.
Liang MH, Socher AS, Larson MG, Schur PH. Reliability and validity of six systems for the clinical assessment of disease activity in systemic lupus erythematosus. Arthritis Rheum 1989; 32(9): 1107-18.
Mok CC, Ho CT, Siu YP, al. Treatment of diffuse proliferative lupus glomerulonephritis: a comparison of two cyclophosphamide- containing regimens. Am J Kidney Dis 2001;38 (2):25
Moreira C, Gama GG. Lupus Eritematoso Sistémico. In : Moreira C, Carvalho MA, Editors. Reumatologia-diagn6stico e tratamento. 2.ed. Rio de Janeiro: Medsi•, 2001.1).423-48.
Niaudet, P. Treatment of lupus nephritis in children. ArchPediatr 1999; 6(12): 1312-21.
Nossent HC, Koldingsnes W. Long-term efficacy of azathioprine treatment for proliferative lupus nephritis. Rheumatology 2000;39(9):96
Okubo T, Ideguchi H, Ihata A, et al. Assessment on intermittent intravenous cyclophosphamide pulse therapy in diffuse proliferative lupus nephritis. Ryumachi2000•,40(3):60
Ter Borg EJ, Horst G, Hummel EJ, Limburg PC, Kallenberg CGM. Measurement of increases in anti-double: stranded DNA antibody levels as a predictor of disease exacerbation in systemic lupus erythematosus. Arthristis Rheum 1990; 33 (5):634-43.
Werkema MCC. Ferramentas estatisticas båsicas para o gerenciamento de processos. Belo Horizonte: Fundaqäo Christiano Ottoni, Escola de Engenharia da UFMG, 1995.
