Beruflich Dokumente
Kultur Dokumente
AND
S SAWADA
KEY WORDS: SYSTEMIC LUPUS ERYTHEMATOSUS; LUPUS NEPHRITIS; PROTEINURIA; RENAL FUNCTION;
ANGIOTENSIN-CONVERTING ENZYME INHIBITOR (ACEI); ANGIOTENSIN II RECEPTOR BLOCKER (ARB);
LOSARTAN
Introduction
The reninangiotensin system is thought to
be involved in the progression of chronic
renal disease of both diabetic and nondiabetic origin.1 It has been shown that
angiotensin-converting
enzyme
(ACE)
inhibitors reduce urinary protein excretion
and attenuate the development of renal
injury.2 The angiotensin II receptor blockers
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STATISTICAL ANALYSIS
Statistical analyses were performed using the
StatView statistical program (SAS Institute
Inc., Cary, NC, USA). Laboratory data before
and after treatment were compared using
Wilcoxons signed rank test. A P-value < 0.05
was considered to be statistically significant.
Results
Seven patients were enrolled in the study and
their baseline clinical characteristics are
shown in Table 1. All the patients were
females of mean SD age 41.1 17.4 years.
The patients were diagnosed with SLE and
had clinical and pathological evidence of
lupus nephritis according to WHO criteria:5
two patients were classified as having WHO
type III SLE, three had WHO type IV SLE, and
two had WHO type V SLE. Prior to treatment,
patients mean SD systolic and diastolic
blood pressures were 147 14 and 93 7
mmHg, respectively. Two patients (numbers
3 and 6 in Table 1) had normal blood
pressure at baseline (defined as systolic blood
pressure < 140 mmHg and/or diastolic blood
pressure < 90 mmHg based on WHO
hypertension criteria.6
The decrease in proteinuria observed after
losartan treatment, expressed as a
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61
27
51
63
18
36
32
F
F
F
F
F
F
F
Sex
40
80
80
80
160
80
160
Anti-nuclear
antibody
titre
2.4
16.5
58.0
40.1
16.2
22.5
14.6
99
69
112
97
131
88
72
Anti-dsDNA
antibody
C3
(IU/ml) (mg/dl)
34
13
22
27
29
21
19
C4
(mg/dl)
43.8
25.4
43.4
43.8
63.3
48.2
46.1
IVb
Vb
III
IVa
Va
IVa
III
16.5
7.5
1.3
1.9
10.1
8.5
1.8
166/96
148/96
128/84
156/100
140/98
134/82
162/96
Total
Urinary
CH50
protein SBP/DBP
(U/ml) WHO type (g/day) (mmHg)
F, female; SBP/DBP, systolic/diastolic blood pressure; WHO, World Health Organization; PSL, prednisolone.
1
2
3
4
5
6
7
Patient
Age
(years)
Complement
PSL
PSL
PSL
PSL
PSL
PSL
PSL
15 mg
18 mg
7.5 mg
15 mg
13 mg
12 mg
20 mg
Therapy
(mg/day)
TABLE 1:
Baseline demographic and clinical characteristics of the patients with systemic lupus erythematosus and evidence of lupus
nephritis who were enrolled in the study
100
80
**
60
**
40
**
**
12
20
0
Baseline
6
Time (months)
Systolic
Diastolic
180
180
160
160
140
120
100
80
60
140
120
100
80
60
Baseline
Baseline
12 months
12 months
FIGURE 2: Blood pressure at baseline and after 12 months of treatment with losartan
in patients with systemic lupus erythematosus and lupus nephritis (*P < 0.05
compared with baseline; seven patients)
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Discussion
Lupus nephritis is one of the most frequent
organ complications of SLE and it is
considered to occur as the result of the
development of deposits of an immune
complex, consisting primarily of dsDNA and
its antibody, in the glomeruli.7 Currently,
lupus nephritis is treated with corticosteroids
NS
80
Serum C4 (mg/dl)
CH50
NS
60
40
20
60
40
20
0
Baseline
12 months
Baseline
Anti-dsDNA antibody
Serum anti-dsDNA antibody (IU/ml)
C4
80
NS
40
30
20
10
12 months
Baseline
12 months
FIGURE 3: Serum complement 4 (C4), total complement activity (CH50) and antidsDNA antibody levels at baseline and after 12 months of treatment with losartan in
patients with systemic lupus erythematosus and lupus nephritis (NS, not statistically
significant compared with baseline; seven patients)
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Serum Cr (mg/dl)
NS
0
Baseline
12 months
Conflicts of interest
The authors had no conflicts of interest to
declare in relation to this article.
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