ABSTRACT
La nefropatía lúpica mensangial (NL II) suele considerarse como de evolución benigna. Se caracteriza por hematuria y proteinuria mínimas, sedimento urinario y valores de depuración de creatinina (DCr) normales. Para evaluar las características clínicas y la evolución de la NL II se estudió a 20 pacientes del Servicio de Reumatología de nuestro centro, con este tipo de nefritis. Encontramos que un porcentaje significativo de estos pacientes no tenía la presentación clínica esperada. Comparamos los datos obtenidos entre los pacientes con presentación considerada clásica y los que tuvieron una presentación atípica. Para la evaluación de los resultados se empleó un análisis estadístico descriptivo y uno inferencial. Los pacientes eran 19 mujeres y 1 varón, con una edad promedio al diagnóstico de la nefropatía de 33,9 años y un tiempo de seguimiento de 4,2 años. Diecisiete de los pacientes tuvieron presentación clínica inusual caracterizada por sedimento urinario anormal (12 pacientes), proteinuria mayor de 1 g/día (7) y disminución en la DCr (14). Dieciséis pacientes presentaron remisión con el tratamiento, con recidiva posterior de la nefritis en 8, que nuevamente respondió al tratamiento. En 5 pacientes se demostró modificación histológica en la nefropatía a NL III y NL IV. Al final del seguimiento, 4 pacientes progresaron a insuficiencia renal crónica. En nuestro grupo de pacientes la NL II no tuvo un comportamiento inicial tan benigno como se describe habitualmente. A pesar de la buena respuesta inicial, el 20% evolucionó a daño renal crónico. La proteinuria inicial y la hiperlipidemia parecen implicar riesgo de evolución más agresiva(AU)
Mesangial lupus nephritis (type II according to the WHO classification) is usually considered a benign variant. Its clinical manifestations are minimal: hematuria and proteinuria, normal sediment, and normal renal function. To evaluate the clinical manifestations and course in mesangial nephritis, we studied 20 patients with a histological diagnosis of type II lupus nephritis who attended our clinic. We found that clinical presentation was atypical in a significant proportion of these patients. Data from the two groups of patients were compared: those with classical presentation and those with atypical presentation. The results were analyzed with descriptive and inferential statistics. Twenty patients (19 women and 1 man) were included. The mean age at nephritis onset was 33.9 years and the mean length of follow-up was 4.2 years. Clinical presentation was atypical in 17 patients, with active urinary sediment in 12, urine protein > 1 g/24 h in 7, and reduction in creatinine clearance in 14. Clinical remission was achieved with treatment in 16 patients, with subsequent flares in 8. All flares responded well to treatment. Biopsies in 5 patients with flares showed progression to type III and IV nephritis. At the end of the follow-up period, 4 patients had chronic renal failure. Some of our patients with mesangial lupus nephritis did not have the benign course that is usually described. Despite a good initial response, 20% of the patients progressed to chronic renal failure. Initial hyperlipidemia and proteinuria seem to correlate with a more aggressive course(AU)
Subject(s)
Humans , Lupus Nephritis/physiopathology , Lupus Erythematosus, Systemic/complications , Hematuria/etiology , Proteinuria/etiology , Glomerulonephritis, Membranoproliferative/physiopathology , Renal Insufficiency, Chronic/etiologyABSTRACT
Mesangial lupus nephritis (type II according to the WHO classification) is usually considered a benign variant. Its clinical manifestations are minimal: hematuria and proteinuria, normal sediment, and normal renal function. To evaluate the clinical manifestations and course in mesangial nephritis, we studied 20 patients with a histological diagnosis of type II lupus nephritis who attended our clinic. We found that clinical presentation was atypical in a significant proportion of these patients. Data from the two groups of patients were compared: those with classical presentation and those with atypical presentation. The results were analyzed with descriptive and inferential statistics. Twenty patients (19 women and 1 man) were included. The mean age at nephritis onset was 33.9 years and the mean length of follow-up was 4.2 years. Clinical presentation was atypical in 17 patients, with active urinary sediment in 12, urine protein>1 g/24 h in 7, and reduction in creatinine clearance in 14. Clinical remission was achieved with treatment in 16 patients, with subsequent flares in 8. All flares responded well to treatment. Biopsies in 5 patients with flares showed progression to type III and IV nephritis. At the end of the follow-up period, 4 patients had chronic renal failure. Some of our patients with mesangial lupus nephritis did not have the benign course that is usually described. Despite a good initial response, 20% of the patients progressed to chronic renal failure. Initial hyperlipidemia and proteinuria seem to correlate with a more aggressive course.
ABSTRACT
In a controlled double blind study the therapeutic efficacy and tolerability of equimolar doses of [1-(p-chlorobenzoyl)-5-methoxy-2-methylindol-3-acetoxy] acetic acid (acemetacin, TV 1322, Rantudil) and indometacin (acemetacin: 180 mg/day, indometacin: 150 mg/day) were studied in 40 patients suffering from rheumatoid arthritis. The period of treatment lasted 42 days. With the exception of the parameter "state of the joint" a statistically confirmed improvement was detectable in the acemetacin group. The parameter "pain" was significantly improved after acemetacin as well after indometacin. With regard to the test criteria "functional disturbances" and "inflammation" only acemetacin was able to achieve a significant improvement. Neither of the antirheumatic agents had a significantly positive influence on the "state of the joint". The therapeutic effect on the course of the disease was better in the group treated with acemetacin than in the group treated with indometacin. However, the difference was not statistically significant. The number of undesired effects which occurred in the acemetacin group was smaller and less pronounced than in the indometacin group. In one instance, the therapy in the acemetacin group was discontinued because of a glossitis and stomatitis. one patient in the control group was excluded from the study owing to heamatemesis.
Subject(s)
Anti-Inflammatory Agents/therapeutic use , Arthritis, Rheumatoid/drug therapy , Indoleacetic Acids/therapeutic use , Indomethacin/therapeutic use , Adult , Aged , Aging , Anti-Inflammatory Agents/adverse effects , Arthritis, Rheumatoid/physiopathology , Chronic Disease , Double-Blind Method , Female , Humans , Indoleacetic Acids/adverse effects , Indomethacin/adverse effects , Male , Middle AgedABSTRACT
Ambulatory patients with a diagnosis of "classical" or "definite" active adult rheumatoid arthritis were selected. They had been stabilized for at least six months previously with oral administration of paramethasone acetate plus various analgesics and/or nonsteroidal anti-inflammatory agents. During an initial period of two to five weeks, the paramethasone dosage was adjusted and other medications replaced by placebo to find the minimum required to keep the patient at a level similar to the one at the beginning of the study. Subsequently, with the double-blind method, the effect of 400 mg naproxen daily was compared with placebo, making periodic and progressive reductions in the corticosteroid dosage, unknown to the patient, until a tolerable minimum was found. The average total observation time was 14 weeks. Results obtained in the first 28 patients showed an average reduction of 57 per cent in paramethasone dose for the group treated with naproxen, versus 21 per cent for the control group. One patient experienced euphoria which could possibly have been related to the test drug. It is concluded that naproxen possesses a significant corticosteroid-sparing effect with negligible toxicity.
