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lupus nephritis treatment

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https://www.readbyqxmd.com/read/28722500/post-marketing-surveillance-study-of-the-long-term-use-of-mizoribine-for-the-treatment-of-lupus-nephritis-2-year-results
#1
Tsutomu Takeuchi, Kenya Okada, Hisao Yoshida, Nobuyuki Yagi
OBJECTIVES: To understand the status of mizoribine use in patients with lupus nephritis (LN) and to collect safety- and efficacy-related data on 2-year treatment with mizoribine. METHODS: A continuous survey was conducted between March 2010 and July 2015. RESULTS: The analysis set included 559 patients (mean age 39.5 years, females 82.6%, mean duration of systemic lupus erythematosus (SLE) 8.4 years, mean duration of LN 5.9 years). Renal function was satisfactory for 6 months, but worsened from 12 months, with significant worsening at 24 months...
July 19, 2017: Modern Rheumatology
https://www.readbyqxmd.com/read/28722110/renal-infiltrating-cd11c-cells-are-pathogenic-in-murine-lupus-nephritis-through-promoting-cd4-t-cell-responses
#2
Xiaofeng Liao, Jingjing Ren, Alec Reihl, Tharshikha Pirapakaran, Bharath Sreekumar, Thomas E Cecere, Christopher M Reilly, Xin M Luo
Lupus nephritis (LN) is a major manifestation of systemic lupus erythematosus (SLE) causing morbidity and mortality in 40-60% of SLE patients. The pathogenic mechanisms of LN are not completely understood. Recent studies have demonstrated the presence of various immune cell populations in lupus nephritic kidneys of both SLE patients and lupus-prone mice. These cells may play important pathogenic or regulatory roles in situ to promote or sustain LN. Here, using lupus-prone mouse models, we showed the pathogenic role of a kidney-infiltrating CD11c(+) myeloid cell population in LN...
July 19, 2017: Clinical and Experimental Immunology
https://www.readbyqxmd.com/read/28720048/mesangial-proliferative-lupus-nephritis-with-podocytopathy-a-special-entity-of-lupus-nephritis
#3
S F Wang, Y H Chen, D Q Chen, Z Z Liu, F Xu, C H Zeng, W X Hu
Mesangial proliferative lupus nephritis may coexist with podocytopathy, but its clinical-morphological features, treatment response and outcomes have not been compared with mesangial proliferative lupus nephritis without podocytopathy. In this study, 125 biopsies of lupus nephritis patients showing mesangial proliferation with mesangial immune deposits were collected and divided into podocytopathy group (defined as podocyte foot process effacement (FPE) >50% with nephrotic syndrome (NS)) and mesangial group (FPE ≤50%, or FPE >50% without NS)...
January 1, 2017: Lupus
https://www.readbyqxmd.com/read/28711905/the-prevalence-subtypes-and-associated-factors-of-hyperuricemia-in-lupus-nephritis-patients-at-chronic-kidney-disease-stages-1-3
#4
Simeng Liu, Yijun Gong, Hong Ren, Wen Zhang, Xiaonong Chen, Tong Zhou, Xiao Li, Nan Chen
There is a high prevalence of hyperuricemia (HUA) in the chronic kidney disease (CKD) population. However, there's a dearth of research on HUA's prevalence, subtypes, early detection, and treatment strategies of HUA in lupus nephritis (LN) patients. The aim of this study is to address these knowledge gaps. LN patients presenting to the Department of Nephrology at Shanghai Rui Jin Hospital from January 2011 to January 2016 were recruited. The effective sample size was derived using the power analysis. The demographic, clinical and laboratory characteristics of the LN patients with HUA were compared with those of patients without HUA...
July 6, 2017: Oncotarget
https://www.readbyqxmd.com/read/28711073/lupus-nephritis-and-pregnancy-concerns-and-management
#5
Liz Lightstone, Michelle A Hladunewich
Pregnancy associated with lupus, especially lupus nephritis, is often fraught with concern for both the mother and fetus. Thus, it is paramount that care begins preconception so that proper planning in terms of optimizing the medical regimen, discontinuation of fetotoxic agents, and treatment of active disease can occur. It is well known that active nephritis at the time of conception is associated with poor outcomes. Even with quiescent disease, recent data indicate that being lupus anticoagulant-positive, nonwhite or Hispanic, and using antihypertensive medications were all predictors of worse pregnancy outcomes...
July 2017: Seminars in Nephrology
https://www.readbyqxmd.com/read/28707410/treatment-of-an-acquired-factor-xiii-inhibitor-in-an-adolescent-with-systemic-lupus-erythematosus-and-renal-failure
#6
Cara A Rabik, Meredith A Atkinson, Sangeeta Sule, John J Strouse
BACKGROUND: Factor (F)XIII deficiency is a rare inherited bleeding disorder, but can also be acquired due to the development of inhibitors. CASE REPORT: A 17-year-old female with systemic lupus erythematosus and end-stage kidney disease secondary to Class IV lupus nephritis developed spontaneous subcutaneous and muscular hematomas and delayed major bleeding after invasive procedures. She had abnormal kaolin thromboelastography (kTEG; decreased maximal amplitude, representative of clot strength) initially attributed to thrombocytopenia and uremic platelet dysfunction, but her FXIII activity was undetectable, and a high-titer antibody against FXIII was identified...
July 13, 2017: Transfusion
https://www.readbyqxmd.com/read/28706383/a-clinico-pathological-study-of-lupus-nephritis-based-on-the-international-society-of-nephrology-renal-pathology-society-2003-classification-system
#7
Suchitha Satish, Pallavi Deka, Manjunath Sanjeev Shetty
INTRODUCTION: Lupus nephritis (LN) is a major complication of systemic lupus erythematosus (SLE). Renal involvement is a major determinant of the prognosis of SLE. The histological classification of LN is a key factor in determining the renal survival of patients with LN. Prompt recognition and treatment of renal disease are important, as early response to therapy is correlated with better outcome and renal biopsy plays an important role in achieving this. OBJECTIVES: The objective of this study was to correlate the clinical and laboratory findings with histopathological classes of LN as per the 2003 International Society of Nephrology-Renal Pathology Society (ISN/RPS) classification system...
July 2017: Journal of Laboratory Physicians
https://www.readbyqxmd.com/read/28701517/mesangial-cell-mammalian-target-of-rapamycin-complex-1-activation-results-in-mesangial-expansion
#8
Kojiro Nagai, Tatsuya Tominaga, Sayo Ueda, Eriko Shibata, Masanori Tamaki, Motokazu Matsuura, Seiji Kishi, Taichi Murakami, Tatsumi Moriya, Hideharu Abe, Toshio Doi
Human glomerular diseases can be caused by several different diseases, many of which include mesangial expansion and/or proliferation followed by glomerulosclerosis. However, molecular mechanisms underlying the pathologic mesangial changes remain poorly understood. Here, we investigated the role of the mammalian target of rapamycin complex 1 (mTORC1)-S6 kinase pathway in mesangial expansion and/or proliferation by ablating an upstream negative regulator, tuberous sclerosis complex 1 (TSC1), using tamoxifen-induced Foxd1-Cre mice [Foxd1ER(+) TSC1 mice]...
July 12, 2017: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/28697806/control-of-lupus-nephritis-by-changes-of-gut-microbiota
#9
Qinghui Mu, Husen Zhang, Xiaofeng Liao, Kaisen Lin, Hualan Liu, Michael R Edwards, S Ansar Ahmed, Ruoxi Yuan, Liwu Li, Thomas E Cecere, David B Branson, Jay L Kirby, Poorna Goswami, Caroline M Leeth, Kaitlin A Read, Kenneth J Oestreich, Miranda D Vieson, Christopher M Reilly, Xin M Luo
BACKGROUND: Systemic lupus erythematosus, characterized by persistent inflammation, is a complex autoimmune disorder with no known cure. Immunosuppressants used in treatment put patients at a higher risk of infections. New knowledge of disease modulators, such as symbiotic bacteria, can enable fine-tuning of parts of the immune system, rather than suppressing it altogether. RESULTS: Dysbiosis of gut microbiota promotes autoimmune disorders that damage extraintestinal organs...
July 11, 2017: Microbiome
https://www.readbyqxmd.com/read/28696253/the-ox40-ox40-ligand-pathway-promotes-pathogenic-th-cell-responses-plasmablast-accumulation-and-lupus-nephritis-in-nzb-w-f1-mice
#10
Jonathan Sitrin, Eric Suto, Arthur Wuster, Jeffrey Eastham-Anderson, Jeong M Kim, Cary D Austin, Wyne P Lee, Timothy W Behrens
Ox40 ligand (Ox40L) locus genetic variants are associated with the risk for systemic lupus erythematosus (SLE); however, it is unclear how Ox40L contributes to SLE pathogenesis. In this study, we evaluated the contribution of Ox40L and its cognate receptor, Ox40, using in vivo agonist and antagonist approaches in the NZB × NZW (NZB/W) F1 mouse model of SLE. Ox40 was highly expressed on several CD4 Th cell subsets in the spleen and kidney of diseased mice, and expression correlated with disease severity. Treatment of aged NZB/W F1 mice with agonist anti-Ox40 mAbs potently exacerbated renal disease, which was accompanied by activation of kidney-infiltrating T cells and cytokine production...
July 10, 2017: Journal of Immunology: Official Journal of the American Association of Immunologists
https://www.readbyqxmd.com/read/28683778/unusual-acute-lupus-hemophagocytic-syndrome-a-test-of-diagnostic-criteria-a-case-report
#11
Wijetunga Mudalige Udai Akalanka Wijetunga, Ravindra Laxman Satarasinghe, Balasuriya Mudiyanselage Dayananda, Ganhewage Kokila Darshani
BACKGROUND: Hemophagocytic lymphohistiocytosis is an aggressive life-threatening syndrome of excessive immune activation. Hemophagocytic lymphohistiocytosis due to systemic lupus erythematosus is described as acute lupus hemophagocytic syndrome. Acute lupus hemophagocytic syndrome presenting with negative antinuclear antibody is uncommon. CASE PRESENTATION: A 57-year-old Sri Lankan woman presented with intermittent fever, weight loss, episodic confusion, and alopecia for 3 months...
July 7, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28683654/efficacy-and-safety-of-multitarget-therapy-with-cyclophosphamide-and-tacrolimus-for-lupus-nephritis-a-prospective-single-arm-single-centre-open-label-pilot-study-in-japan
#12
R Sakai, T Kurasawa, E Nishi, T Kondo, Y Okada, A Shibata, K Nishimura, K Chino, A Okuyama, H Takei, H Nagasawa, K Amano
Background Pulsed cyclophosphamide or mycophenolate mofetil for lupus nephritis has limited efficacy. We previously reported a case of mixed-class IV + V lupus nephritis successfully treated with cyclophosphamide and tacrolimus. This study assessed the efficacy and safety of multitarget therapy with cyclophosphamide and tacrolimus for the treatment of lupus nephritis. Methods In a prospective, single-arm, open label pilot study, we recruited 15 patients aged 18-64 years with active lupus nephritis who met the American College of Rheumatology criteria for a diagnosis of systemic lupus erythematosus (1997)...
January 1, 2017: Lupus
https://www.readbyqxmd.com/read/28682905/rituximab-alone-as-induction-therapy-for-membranous-lupus-nephritis-a-multicenter-retrospective-study
#13
Nathalie Chavarot, David Verhelst, Agathe Pardon, Valérie Caudwell, Lucile Mercadal, Antoinette Sacchi, Catherine Leonardi, Véronique Le Guern, Alexandre Karras, Eric Daugas
The optimal treatment for pure membranous lupus nephritis (MLN) remains undetermined. Rituximab constitutes a promising therapeutic option for lupus nephritis and is currently being evaluated for use in idiopathic membranous nephritis. We retrospectively analysed the efficacy and tolerance of rituximab as a monotherapy in the induction treatment of pure MLN.We retrospectively investigated SLE patients with biopsy-proven pure class V lupus nephritis presenting with a protein-to-creatinine ratio of at least 2 g/g and treated with rituximab as monotherapy...
July 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28680823/efficacy-and-safety-of-adding-mizoribine-to-standard-treatment-in-patients-with-immunoglobulin-a-nephropathy-a-randomized-controlled-trial
#14
Keiji Hirai, Susumu Ookawara, Taisuke Kitano, Haruhisa Miyazawa, Kiyonori Ito, Yuichirou Ueda, Yoshio Kaku, Taro Hoshino, Honami Mori, Izumi Yoshida, Kenji Kubota, Yasuyoshi Yamaji, Tetsuro Takeda, Yoshikazu Nakamura, Kaoru Tabei, Yoshiyuki Morishita
BACKGROUND: Mizoribine (MZR) is an immunosuppressive drug used in Japan for treating patients with lupus nephritis and nephrotic syndrome and has been also reportedly effective in patients with immunoglobulin A (IgA) nephropathy. However, to date, few randomized control studies of MZR are performed in patients with IgA nephropathy. Therefore, this prospective, open-label, randomized, controlled trial aimed to investigate the efficacy and safety of adding MZR to standard treatment in these patients, and was conducted between April 1, 2009, and March 31, 2016, as a multicenter study...
June 2017: Kidney Research and Clinical Practice
https://www.readbyqxmd.com/read/28673504/additional-improvements-in-clinical-response-from-adjuvant-biologic-response-modifiers-in-adults-with-moderate-to-severe-systemic-lupus-erythematosus-despite-immunosuppressive-agents-a-systematic-review-and-meta-analysis
#15
REVIEW
Tatyana A Shamliyan, Paula Dospinescu
PURPOSE: The role of biologic disease-modifying drugs in patients with systemic lupus erythematosus (SLE) remains controversial. METHODS: Following systematic review and meta-analysis protocol, we searched PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov in January 2017 to identify all studies of people with SLE treated with biologic response modifiers. We performed direct frequentist random effects meta-analyses, calculated pooled relative risk and number needed to treat to achieve an outcome in 1 patient (NNT) as reciprocal to statistically significant absolute risk difference, and graded the quality of evidence by using the Grading of Recommendations Assessment, Development, and Evaluation criteria...
June 30, 2017: Clinical Therapeutics
https://www.readbyqxmd.com/read/28669995/redefining-lupus-nephritis-clinical-implications-of-pathophysiologic-subtypes
#16
REVIEW
Feng Yu, Mark Haas, Richard Glassock, Ming-Hui Zhao
Systemic lupus erythematosus (SLE) is associated with a broad spectrum of clinical and immunologic manifestations, of which lupus nephritis is the most common cause of morbidity and mortality. The development of nephritis in patients with SLE involves multiple pathogenic pathways including aberrant apoptosis, autoantibody production, immune complex deposition and complement activation. The 2003 International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification system for lupus nephritis was widely accepted with high intraobserver and interobserver concordance to guide therapeutic strategy and provide prognostic information...
August 2017: Nature Reviews. Nephrology
https://www.readbyqxmd.com/read/28668803/longterm-data-on-disease-flares-in-patients-with-proliferative-lupus-nephritis-in-recent-years
#17
Desmond Y H Yap, Colin Tang, Maggie K M Ma, Maggie M Y Mok, Gary C W Chan, Lorraine P Y Kwan, Tak Mao Chan
OBJECTIVE: To examine the disease flare rate in lupus nephritis (LN), focusing on renal flares, and the factors associated with relapse risk in recent years. METHODS: We analyzed data on 139 Chinese patients with class III/IV ± V LN diagnosed from January 1983 to December 2013. We also compared data before and after 1998, when maintenance immunosuppression was changed from azathioprine (AZA) to mycophenolic acid (MPA). RESULTS: Over 112.5 ± 88...
July 1, 2017: Journal of Rheumatology
https://www.readbyqxmd.com/read/28663794/recent-advances-in-the-understanding-of-renal-inflammation-and-fibrosis-in-lupus-nephritis
#18
REVIEW
Susan Yung, Desmond Yh Yap, Tak Mao Chan
Lupus nephritis is a potentially reversible cause of severe acute kidney injury and is an important cause of end-stage renal failure in Asians and patients of African or Hispanic descent. It is characterized by aberrant exaggerated innate and adaptive immune responses, autoantibody production and their deposition in the kidney parenchyma, triggering complement activation, activation and proliferation of resident renal cells, and expression of pro-inflammatory and chemotactic molecules leading to the influx of inflammatory cells, all of which culminate in destruction of normal nephrons and their replacement by fibrous tissue...
2017: F1000Research
https://www.readbyqxmd.com/read/28649578/anti-high-mobility-group-box-1-antibody-ameliorates-albuminuria-in-mrl-lpr-lupus-prone-mice
#19
Haruki Watanabe, Katsue S Watanabe, Keyue Liu, Sumie Hiramatsu, Sonia Zeggar, Eri Katsuyama, Noriko Tatebe, Akiya Akahoshi, Fumiaki Takenaka, Takahisa Hanada, Masaru Akehi, Takanori Sasaki, Ken-Ei Sada, Eiji Matsuura, Masahiro Nishibori, Jun Wada
We evaluated the efficacy of a neutralizing anti-high mobility group box 1 (HMGB1) monoclonal antibody in MRL/lpr lupus-prone mice. The anti-HMGB1 monoclonal antibody (5 mg/kg weight) or class-matched control immunoglobulin G2a (IgG2a) was administered intravenously twice a week for 4-15 weeks. Urine albumin was monitored, and histological evaluation of the kidneys was conducted at 16 weeks. Lymphadenopathies were evaluated by 1-(2'-deoxy-2'-[(18)F]fluoro-β-D-arabinofuranosyl)cytosine ([(18)F]FAC) positron emission tomography/computed tomography (PET/CT) at 12 weeks...
September 15, 2017: Molecular Therapy. Methods & Clinical Development
https://www.readbyqxmd.com/read/28646040/il-23-limits-the-production-of-il-2-and-promotes-autoimmunity-in-lupus
#20
Hong Dai, Fan He, George C Tsokos, Vasileios C Kyttaris
The IL-23/IL-17 pathway is important in multiple autoimmune diseases, but its effect on lupus pathology remains unclear, with opposing trials in murine models of the disease. In this study, we show a disease activity-related upregulation of serum IL-23 and IL-23 receptor in patients with systemic lupus erythematosus (SLE) as compared with healthy controls. When added in SLE T cell in vitro cultures, IL-23 induced IL-17 and limited IL-2 production, whereas T follicular helper and double negative (DN) T cells significantly expanded...
June 23, 2017: Journal of Immunology: Official Journal of the American Association of Immunologists
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