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Review

Lupus nephritis: a clinical review for practicing nephrologists

G. Contreras, D. Roth, V. Pardo, L.G. Striker and D.R. Schultz

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Volume 57 (2002) p. 95 - 107

Abstract

G. Contreras, D. Roth, V. Pardo, L.G. Striker and D.R. Schultz

¹Dialysis Unit VAMC, ²Division of Nephrology, ³Electron Microscopy VAMC, ⁴Renal Cell Biology Laboratory and ⁵Division of Rheumatology and Immunology, Veterans Affairs Medical Center and University of Miami School of Medicine, Miami, FL, USA
The renal manifestations in systemic lupus erythematosus (SLE) are protean and difficult to categorize into clinical syndromes and histologic classes. Lupus nephritis is frequently unrecognized until full-blown nephritic and/or nephrotic syndrome with renal failure emerge. Epidemiologically, approximately one third of SLE patients from unselected populations have renal involvement early during the disease. Most renal abnormalities emerge within the first few years of SLE diagnosis. Currently, most nephrologists agree that an early renal biopsy is worthwhile in those SLE patients with abnormal urinalysis and/or reduced renal function. First, it provides a histologic categorization of the glomerulonephritis as well as an assessment of the degree of activity and chronicity. Second, it provides vital prognostic information. Third, it is beneficial in planning a more rational therapy with or without potentially toxic immunosuppressive agents. Over the last 3 decades, many controlled clinical trials for treatment of lupus nephritis have been completed with a few therapeutic immunosuppressive regimens. Among those agents used, cyclophosphamide and azathioprine provide a reduction of morbidity in those patients afflicted with proliferative forms of lupus glomerulonephritis. A new immunosuppressive agent, mycophenolate mofetil, is being studied for treatment of proliferative forms of lupus glomerulonephritis in a controlled clinical trial at our institution. Immunosuppressive agents and the availability of dialysis and transplantation have improved the survival of patients with lupus nephritis, in particular those with proliferative forms.

Original

Chronic kidney disease after orthotopic liver transplantation in recipients receiving tacrolimus

G. Garces, G. Contreras, D. Carvalho, I.M. Jaraba, C. Carvalho, A. Tzakis, J. Moon, K. Ratnam and D. Roth

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42.00 $

Volume 75 (2011) p. 150 - 157

Abstract

Clinical Nephrology, Vol. 75 – No. 2/2011 (150-157)

Chronic kidney disease after orthotopic liver transplantation in recipients receiving tacrolimus

G. Garces¹, G. Contreras², D. Carvalho³, I.M. Jaraba², C. Carvalho⁴, A. Tzakis⁵, J. Moon⁵, K. Ratnam¹ and D. Roth²

¹Denver Nephrology PC, Denver, CO, ²Division of Nephrology and Hypertension, ³PGY-¹ General Surgery, ⁴PGY-¹ Internal Medicine, Jackson Memorial Hospital, and ⁵Division of Transplantation, University of Miami, Miller School of Medicine, Miami, FL, USA
Introduction: Chronic kidney disease (CKD) is common in liver transplant recipients receiving calcineurin inhibitors. Method and population: The goals of this case-control study were to identify risk factors associated with CKD and its effect on mortality in 294 liver transplant recipients receiving calcineurin inhibition with tacrolimus. Results: Hepatitis C virus (HCV) was the most common indication (42%) for transplantation. CKD 4 and 5 (estimated glomerular filtration rate (eGFR) of <= 29 ml/min/1.73 m²) developed in 10.8% of recipients during a mean follow-up of 52 months. The incidence density of CKD was 2.56 per 100 patient-years. End-stage renal disease developed in 2.7%. By univariate analysis, CKD patients were older (mean ± sd, 57 ± 10 vs. 51 ± 11, p < 0.05) with hypertension (56 vs. 32%, p < 0.05), had lower preoperative hematocrit (31 ± 6 vs. 34 ± 5, p < 0.05), alanine aminotransferase (median (95% confidence limit) 46 (34 – 80) vs. 68 (56 – 77), < 0.05) and eGFR (56 ± 28 vs. 91 ± 35 ml/ min/1.73 m², p < 0.05), had higher preoperative prothrombin time (16.1 (14.6 – 17.2) vs. 14.8 (14.5 – 15.1) seconds, p < 0.05), and required more perioperative renal replacement therapy (RRT) (41% vs. 6.5%, p < 0.05) compared to controls. Perioperative need for RRT (hazard ratio (95% CI) 2.72 (1.05 – 7.03)) and lower preoperative eGFR: 60 – 89 (4.08 (1.23 – 13.5)), 30 – 59 (4.26 (1.18 – 15.36)), and <= 29 (5.91 ((1.28 – 27.19)) vs. eGFR >= 90 ml/min/1.73 m² were independently associated with development of CKD adjusting for important covariates. The development of CKD (2.36 (1.22 – 4.59)) was independently associated with late mortality with an attributable risk of 12.8%. Conclusion: Data demonstrate that CKD is an important clinical event associated with increased risk for death after primary liver transplantation.Correspondence to:
G. Contreras. MD, MPH
University of Miami, Miller School of
Medicine
Division of Nephrology and Hypertension
Clinical Research Building
1120 NW 14th Street, Suite 360 E
Miami, FL 33136, USA
Email: [email protected]

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