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Hydroxychloroquine and renal disease

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https://www.readbyqxmd.com/read/27793432/new-onset-of-lupus-nephritis-in-two-patients-with-sle-shortly-after-initiation-of-treatment-with-belimumab
#1
Chrysanthi Staveri, Dimitrios Karokis, Stamatis-Nick C Liossis
PURPOSE: Belimumab is currently approved for the treatment of patients with active SLE despite standard treatment. However, it has not been formally tested for patients with lupus nephritis because such patients had been excluded from the clinical trials. In this report, we present two patients with SLE who developed lupus nephritis de novo shortly after belimumab treatment initiation; both patients improved rapidly upon belimumab discontinuation. RESULTS: The first patient (a 30-year-old female, with a 15-year disease duration, receiving prednisolone, hydroxychloroquine, and azathioprine, with no previous history of nephritis that was repeatedly anti-dsDNA negative) had exacerbation of a facial butterfly-like rash developed after 3 months of belimumab treatment initiation...
September 28, 2016: Seminars in Arthritis and Rheumatism
https://www.readbyqxmd.com/read/27771618/juvenile-systemic-lupus-erythematosus-in-nigeria
#2
O O Adelowo, B H Olaosebikan, B A Animashaun, R O Akintayo
Juvenile systemic lupus erythematosus (JSLE) is a complex multisystemic autoimmune disorder of unknown cause. It accounts for about one in five cases of SLE. The tendency for SLE to run a fulminant course when it starts in childhood has made JSLE a potentially more severe disease than adult SLE. Reports of JSLE from sub-Saharan Africa are scanty in spite of the increasing reports of adult SLE. We conducted a 4-year retrospective study of JSLE cases seen at the Lagos State University Teaching Hospital between January 2010 and December 2014...
October 21, 2016: Lupus
https://www.readbyqxmd.com/read/27741124/concurrent-kimura-disease-and-lupus-nephritis-a-case-report
#3
Haitao Wang, Fang Fang, Ying Sun, Songlan Wang, Yonghui Mao
BACKGROUND: Kimura disease is a rare chronic inflammatory disorder with peripheral eosinophilia and elevated serum IgE and is also frequently complicated by nephropathy. METHODS: We report a rare case of Kimura disease concomitant with lupus nephritis in a 72-year old male patient with recurrent unexplained lymphadenopathy, renal lesions, and immunologic abnormalities. RESULTS: The patient was successfully managed with gamma immunoglobulin, intravenous pulse methylprednisolone therapy, hydroxychloroquine, and prednisone...
October 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27591827/end-stage-renal-disease-in-patients-with-rheumatoid-arthritis
#4
Sunita Paudyal, Frances M Yang, Christopher Rice, Chen-Chun Chen, Michael Skelton, Monique Bethel, Shilpa Brown, Norris Stanley Nahman, Laura Carbone
OBJECTIVES: To determine the frequency of end-stage renal disease (ESRD) in patients with rheumatoid arthritis (RA), the causes of ESRD, and the treatment of RA in the setting of ESRD. METHODS: Cross-sectional study of RA (N = 3754) and non-RA (N = 326,776) patients in the United States Renal Data System (USRDS) during 2011 (N = 330,530). The epidemiology of ESRD in RA was determined and the etiology of ESRD in patients with and without RA was compared. The frequency of patients with RA with at least one filled prescription for prednisone/prednisolone, a DMARD, and/or a biologic in 2011 was determined...
August 2, 2016: Seminars in Arthritis and Rheumatism
https://www.readbyqxmd.com/read/27548593/systemic-lupus-erythematosus-primary-care-approach-to-diagnosis-and-management
#5
Nguyet-Cam Vu Lam, Maria V Ghetu, Marzena L Bieniek
Systemic lupus erythematosus is an autoimmune disease that affects many systems, including the skin, musculoskeletal, renal, neuropsychiatric, hematologic, cardiovascular, pulmonary, and reproductive systems. Family physicians should be familiar with the manifestations of lupus to aid in early diagnosis, monitoring patients with mild disease, recognizing warning signs that require referral to a rheumatologist, and helping to monitor disease activity and treatment in patients with moderate to severe disease...
August 15, 2016: American Family Physician
https://www.readbyqxmd.com/read/27496151/fetal-outcome-and-recommendations-of-pregnancies-in-lupus-nephritis-in-the-21st-century-a-prospective-multicenter-study
#6
Gabriella Moroni, Andrea Doria, Elisa Giglio, Chiara Tani, Margherita Zen, Francesca Strigini, Barbara Zaina, Angela Tincani, Federica de Liso, Caterina Matinato, Claudia Grossi, Mariele Gatto, Paola Castellana, Monica Limardo, Pier Luigi Meroni, Piergiorgio Messa, Pietro Ravani, Marta Mosca
The aim of this multicenter study was to assess the present risk of fetal complications and the inherent risk factors in pregnant women with lupus nephritis. Seventy-one pregnancies in 61women (59 Caucasians and 2 Asians) with lupus nephritis were prospectively followed between October 2006 and December 2013. All patients received a counselling visit within 3 months before the beginning of pregnancy and were followed by a multidisciplinary team. At baseline mild active nephritis was present in 15 cases (21...
November 2016: Journal of Autoimmunity
https://www.readbyqxmd.com/read/27478650/life-threatening-severe-qtc-prolongation-in-patient-with-systemic-lupus-erythematosus-due-to-hydroxychloroquine
#7
John P O'Laughlin, Parag H Mehta, Brian C Wong
We present a case of a syncopal episode resulting from significant QT interval prolongation in a patient on hydroxychloroquine for the treatment of systemic lupus erythematosus and end stage renal disease. The patient had been treated with hydroxychloroquine for two years prior to presentation. After thorough workup for secondary causes of QT interval prolongation hydroxychloroquine was discontinued and the patient's QT interval shortened. The patient was treated with mexiletine to prevent sudden ventricular arrhythmias, which was unique compared to other documented cases in which lidocaine was used...
2016: Case Reports in Cardiology
https://www.readbyqxmd.com/read/27457513/eular-recommendations-for-women-s-health-and-the-management-of-family-planning-assisted-reproduction-pregnancy-and-menopause-in-patients-with-systemic-lupus-erythematosus-and-or-antiphospholipid-syndrome
#8
L Andreoli, G K Bertsias, N Agmon-Levin, S Brown, R Cervera, N Costedoat-Chalumeau, A Doria, R Fischer-Betz, F Forger, M F Moraes-Fontes, M Khamashta, J King, A Lojacono, F Marchiori, P L Meroni, M Mosca, M Motta, M Ostensen, C Pamfil, L Raio, M Schneider, E Svenungsson, M Tektonidou, S Yavuz, D Boumpas, A Tincani
OBJECTIVES: Develop recommendations for women's health issues and family planning in systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS). METHODS: Systematic review of evidence followed by modified Delphi method to compile questions, elicit expert opinions and reach consensus. RESULTS: Family planning should be discussed as early as possible after diagnosis. Most women can have successful pregnancies and measures can be taken to reduce the risks of adverse maternal or fetal outcomes...
July 25, 2016: Annals of the Rheumatic Diseases
https://www.readbyqxmd.com/read/27390146/factors-related-to-blood-hydroxychloroquine-concentration-in-patients-with-systemic-lupus-erythematosus
#9
Ji Yeon Lee, Jennifer Lee, Seung Ki Kwok, Ji Hyeon Ju, Kyung Su Park, Sung-Hwan Park
OBJECTIVE: To identify factors associated with blood concentrations of hydroxychloroquine (HCQ) and its major metabolite, N-desethylhydroxychloroquine (DHCQ), in patients with systemic lupus erythematosus (SLE) receiving long-term oral HCQ treatment. METHODS: SLE patients who had been taking HCQ for more than 3 months were recruited. Various clinical characteristics, laboratory values, and SLE disease activity index (SLEDAI) scores were examined. The concentration of HCQ and DHCQ ([HCQ] and [DHCQ]) was measured by liquid chromatography-mass spectrometry, and the relationship between [HCQ], [DHCQ], and [HCQ]/[DHCQ] ratio to various factors was investigated...
July 7, 2016: Arthritis Care & Research
https://www.readbyqxmd.com/read/27169353/pediatric-lupus-nephritis-presenting-with-terminal-renal-failure
#10
Martine T P Besouw, Johan G Vande Walle, Mohamad I Ilias, Ann M Raes, Agnieszka A Prytula, Lieve Claeys, Jo L Dehoorne
A 12-year-old Congolese girl presented with acute renal failure, edema, hypertension, hemoptysis, hematuria, and proteinuria after a history of throat infection. Renal ultrasound showed kidneys of normal size, with increased echogenicity of the cortical parenchyma and decreased corticomedullary differentiation. Other additional investigations showed pancytopenia with decreased complement (low C3 and C4). Antinuclear antibodies were strongly positive, including anti-double stranded DNA. Renal biopsy confirmed severe grade IV lupus nephritis...
December 2016: Acta Clinica Belgica
https://www.readbyqxmd.com/read/26992838/recommendations-on-screening-for-chloroquine-and-hydroxychloroquine-retinopathy-2016-revision
#11
Michael F Marmor, Ulrich Kellner, Timothy Y Y Lai, Ronald B Melles, William F Mieler
BACKGROUND: The American Academy of Ophthalmology recommendations on screening for chloroquine (CQ) and hydroxychloroquine (HCQ) retinopathy are revised in light of new information about the prevalence of toxicity, risk factors, fundus distribution, and effectiveness of screening tools. PATTERN OF RETINOPATHY: Although the locus of toxic damage is parafoveal in many eyes, Asian patients often show an extramacular pattern of damage. DOSE: We recommend a maximum daily HCQ use of ≤5...
June 2016: Ophthalmology
https://www.readbyqxmd.com/read/26911274/hydroxychloroquine-in-patients-with-systemic-lupus-erythematosus-with-end-stage-renal-disease
#12
Monique Bethel, Frances M Yang, Shuang Li, N Stanley Nahman, Alyce M Oliver, Wambui Machua, Laura D Carbone
OBJECTIVES: To determine dosing patterns and examine predictors of filled hydroxychloroquine (HCQ) prescriptions in patients with systemic lupus erythematosus (SLE) with end-stage renal disease (ESRD). METHODS: This was a retrospective cohort study of patients with SLE in the US Renal Data System (USRDS) database in fiscal year 2011. All patients were Medicare Part D beneficiaries. Patients with a diagnosis of SLE were identified by the International Classification of Diseases, 9th revision code 710...
April 2016: Journal of Investigative Medicine: the Official Publication of the American Federation for Clinical Research
https://www.readbyqxmd.com/read/26845207/-management-of-antirheumatic-drugs-in-kidney-failure
#13
Rocco Manganelli, Serena Manganelli, Salvatore Iannaccone, Walter De Simone
The nephrologist deals with the management of patients with rheumatic disease, both diagnostically and therapeutically. He must determine whether the renal pathology is related to the rheumatologic disease, mostly through the use of the renal biopsy. In the second case, he must know the nephrotoxic potential of the drugs prescribed and adjust their use to the degree of renal impairment. This task is made difficult by the absence of controlled clinical trials regarding their use on patients with renal insufficiency or on chronic dialysis...
November 2015: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
https://www.readbyqxmd.com/read/26749299/hydroxychloroquine-serum-concentrations-and-flares-of-systemic-lupus-erythematosus-a-longitudinal-cohort-analysis
#14
Chi Chiu Mok, Hannah J Penn, Kar Li Chan, Sau Mei Tse, Loralie J Langman, Paul J Jannetto
OBJECTIVE: To study the relationship between serum hydroxychloroquine (HCQ) concentrations and flares of systemic lupus erythematosus (SLE) in a longitudinal cohort of patients. METHODS: Patients who fulfilled ≥4 American College of Rheumatology classification criteria for SLE and had been treated with HCQ for >6 months were studied. Blood was assayed for HCQ levels by tandem mass spectrometry. Patients were serially assessed for disease activity, using the Safety of Estrogens in Lupus Erythematosus National Assessment (SELENA) version of the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and flares (SELENA flares instrument)...
September 2016: Arthritis Care & Research
https://www.readbyqxmd.com/read/26511966/garre-s-sclerosing-osteomyelitis-caused-by-salmonella-group-d-in-a-patient-with-systemic-lupus-erythematosus-an-unusual-complication
#15
Claudia Elera-Fitzcarrald, José L Alfaro-Lozano, César A Pastor-Asurza
We report the case of a 35-year-old male, who was diagnosed with systemic lupus erythematosus (SLE) in 2010 based on the presence of articular, serous, renal, immune, and hematologic involvement. He also had secondary antiphospholipid syndrome (APS). He was treated with prednisone 10 mg per day, hydroxychloroquine 200 mg per day, methotrexate 12.5 mg per week, leflunomide 20 mg per day, and oral anticoagulation previous to the present event. He presented to emergency room with a 7 day disease duration characterized by pain in the left thigh, which increased with physical activity, resulting in claudication; he also had malaise and fever...
December 2015: Clinical Rheumatology
https://www.readbyqxmd.com/read/26471017/lupus-nephritis-an-update
#16
Tasnim F Imran, Frederick Yick, Suneet Verma, Christopher Estiverne, Chinonye Ogbonnaya-Odor, Srikanth Thiruvarudsothy, Alluru S Reddi, Neil Kothari
Lupus nephritis (LN) is an inflammatory condition of the kidneys that encompasses various patterns of renal disease including glomerular and tubulointerstitial pathology. It is a major predictor of poor prognosis in patients with systemic lupus erythematosus (SLE). Genetic factors, including several predisposing loci, and environmental factors, such as EBV and ultraviolet light, have been implicated in the pathogenesis. It carries a high morbidity and mortality if left untreated. Renal biopsy findings are utilized to guide treatment...
February 2016: Clinical and Experimental Nephrology
https://www.readbyqxmd.com/read/26428520/hydroxychloroquine-related-retinal-toxicity
#17
REVIEW
Hui Jen Ding, Alastair K Denniston, Vijay K Rao, Caroline Gordon
HCQ is widely used for the treatment of rheumatic diseases, particularly lupus and RA. It is generally well tolerated, but retinopathy is a concern. Retinopathy is rare, but is sight threatening, generally irreversible and may progress even after cessation of therapy. Damage may be subclinical. Although a number of risk factors have been proposed (such as duration of therapy and cumulative dose), the many exceptions (e.g. retinopathy on low-dose HCQ, or no retinopathy after a very large cumulative dose of HCQ) highlight our limited understanding of the disease process...
June 2016: Rheumatology
https://www.readbyqxmd.com/read/26428205/hydroxychloroquine-blood-levels-in-systemic-lupus-erythematosus-clarifying-dosing-controversies-and-improving-adherence
#18
COMPARATIVE STUDY
Laura Durcan, William A Clarke, Laurence S Magder, Michelle Petri
OBJECTIVE: Hydroxychloroquine (HCQ) is used for its effect on systemic lupus erythematosus (SLE) disease activity and longterm benefits. This can be limited by adherence. One way to assess adherence is to measure blood levels. Conflicting data exist regarding blood levels and disease activity. There is disagreement about dosing; rheumatologists recommend weight-based dosing while some other specialists advocate height-based "ideal body weight" dosing. METHODS: Patients were prescribed HCQ not exceeding 6...
November 2015: Journal of Rheumatology
https://www.readbyqxmd.com/read/26414017/impact-of-hydroxychloroquine-on-atherosclerosis-and-vascular-stiffness-in-the-presence-of-chronic-kidney-disease
#19
Ashutosh M Shukla, Chhanda Bose, Oleg K Karaduta, Eugene O Apostolov, Gur P Kaushal, Tariq Fahmi, Mark S Segal, Sudhir V Shah
Cardiovascular disease is the largest cause of morbidity and mortality among patients with chronic kidney disease (CKD) and end-stage kidney disease, with nearly half of all deaths attributed to cardiovascular disease. Hydroxychloroquine (HCQ), an anti-inflammatory drug, has been shown to have multiple pleiotropic actions relevant to atherosclerosis. We conducted a proof-of-efficacy study to evaluate the effects of hydroxychloroquine in an animal model of atherosclerosis in ApoE knockout mice with and without chronic kidney disease...
2015: PloS One
https://www.readbyqxmd.com/read/26384980/pregnancy-outcome-of-126-anti-ssa-ro-positive-patients-during-the-past-24-years-a-retrospective-cohort-study
#20
Yan Luo, Lili Zhang, Yunyun Fei, Yiqun Li, Donglin Hao, Yi Liu, Yan Zhao
The aims of our study are to observe the pregnancy outcome of anti-Sjögren's syndrome-related antigen A (SSA)/Ro-positive women and to predict the risk factors for adverse pregnancy outcome and neonatal lupus erythematosus (NLE). Clinical data of 126 anti-SSA/Ro-positive patients with 140 pregnancies were evaluated retrospectively, and the newborns were followed up as a cohort in 3 months. χ (2) test or logistic regression was used to predict the risk factors of lupus flares during pregnancy, fetal loss, and NLE...
October 2015: Clinical Rheumatology
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