java barcode scanner library DISEASES DEMONSTRATING NEPHRITIC & NEPHROTIC COMPONENTS SYSTEMIC LUPUS ERYTHEMATOSUS in Objective-C

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DISEASES DEMONSTRATING NEPHRITIC & NEPHROTIC COMPONENTS SYSTEMIC LUPUS ERYTHEMATOSUS
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Systemic lupus erythematosus is a systemic autoimmune disease in which renal involvement is common In various series, clinical renal involvement ranges from 35% to 90% (see 20) Patients present with glomerular syndromes such as nephritic or nephrotic syndromes and asymptomatic renal disease Nonglomerular syndromes include tubulointerstitial
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Flanc RS et al Treatment for lupus nephritis Cochrane Database Syst Rev 2004;(1):CD002922 [PMID: 14973998] Ginzler EM et al Mycophenolate mofetil or intravenous cyclophosphamide for lupus nephritis N Engl J Med 2005 Nov 24;353(21):2219 28 [PMID: 16306519]
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nephritis and vasculitis All patients with systemic lupus erythematosus should have routine urinalyses to monitor for the appearance of hematuria or proteinuria If urinary abnormalities are detected, renal biopsy is often performed The type of glomerular injury depends on the site of immune complex deposition The World Health Organization (WHO) classification of renal glomerular lesions follows: type I, normal; type II, mesangial proliferative; type III, focal and segmental proliferative; type IV, diffuse proliferative; and type V, membranous nephropathy These are further classified as acute or chronic and global or segmental, both of which seem to have prognostic value
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Renal disease in the setting of hepatitis C viral infection was not well-recognized until 1993 Now it accounts for approximately 8% of patients with ESRD Three clinicopathologic glomerular syndromes associated with hepatitis C are secondary membranoproliferative glomerulonephritis, cryoglobulinemic glomerulonephritis, and membranous nephropathy A type I membranoproliferative glomerulonephritis (MPGN) is the most common lesion in patients requiring renal biopsy These patients typically have hematuria and proteinuria, hypertension, and anemia Occasionally, they exhibit the nephrotic syndrome Many have elevated serum transaminases and an elevated rheumatoid factor Of patients studied in one series, 50% had hepatomegaly Hypocomplementemia is very common, with C4 typically more reduced than C3 Cryoglobulinemic disease is discussed above Membranous glomerulopathy is the least common of the three and presents with a typical nephrotic picture Neither cryoglobulins nor rheumatoid factor is present
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Individuals with type I and type II patterns require no treatment Transformation of these types to a more active lesion is usually accompanied by an increase in lupus serologic activity and evidence of deteriorating renal function (eg, rising serum creatinine, increasing proteinuria) Repeat biopsy to confirm the transformation in these patients is standard Patients with extensive type III lesions and all type IV lesions should receive aggressive immunosuppressive therapy Poorest prognostic features in patients with type IV lesions are an elevated serum creatinine, hematocrit less than 26%, and black race Indications for treatment of type V disease are unclear; however, if superimposed proliferative lesions exist, aggressive therapy should be instituted Corticosteroids are the mainstay of treatment (methylprednisolone 1 g intravenously daily for 3 days followed by prednisone, 60 mg orally daily for 4 6 weeks) but are associated with many side effects and may not prevent progression of chronic lesions Cytotoxic agents, such as cyclophosphamide, are necessary adjuncts because they improve long-term renal survival in patients with aggressive type III and type IV nephritis However, studies have shown the potential benefit of mycophenolate mofetil as an alternative form of induction therapy In one randomized noninferiority study, patients using mycophenolate mofetil had similar rates of full remission at 24 weeks in comparison to those using cyclophosphamide These agents are typically used for 18 24 months (eg, cyclophosphamide intravenously every month for six doses and then every 3 months for six doses) Studies suggest that mycophenolate mofetil is less toxic than cyclophosphamide, does not cause ovarian failure, and may be more acceptable to patients, although long-term follow-up needs to be examined Ongoing trials of other therapies include cyclosporine and azathioprine as longer-term options The return of serologic measurements to normal can be useful in monitoring treatment Markers include double-stranded DNA (dsDNA) antibodies, C3, C4, CH50, and serum creatinine Urinary protein and sediment are also helpful markers Patients with systemic lupus erythematosus who undergo dialysis have a favorable prospect for long-term survival Patients with kidney transplants have recurrent renal disease in 8% of cases
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Contreras G et al Sequential therapies for proliferative lupus nephritis N Engl J Med 2004 Mar 4;350(10):971 80 [PMID: 14999109] Fine DM Pharmacological therapy of lupus nephritis JAMA 2005 Jun 22;293(24):3053 60 [PMID: 15972568]
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