ABSTRACT
Eight patients with refractory lupus nephritis received rituximab after failing standard sequential therapy and were followed for 104 weeks after the infusion. One patient died secondary to a complicated pregnancy but had stable renal function. Three patients received a re-infusion of rituximab approximately 12 months apart due to a renal flare; during the second year of follow-up, those patients progressed toward ESRD. The four remaining patients demonstrated improvements in SLEDAI score, CrCl, and proteinuria with maintenance of their standard immunosuppressive therapy and did not require a re-infusion of rituximab. Although rituximab as induction therapy for refractory lupus nephritis has been shown to have a good response, its efficacy in long-term assessments demonstrates disappointing results.
Subject(s)
Antibodies, Monoclonal, Murine-Derived/administration & dosage , Antigens, CD20/immunology , Immunologic Factors/administration & dosage , Lupus Nephritis/drug therapy , Adult , Biomarkers/blood , Creatinine/blood , Disease Progression , Drug Administration Schedule , Drug Resistance , Drug Substitution , Female , Follow-Up Studies , Humans , Immunosuppressive Agents/therapeutic use , Infusions, Intravenous , Kidney Failure, Chronic/etiology , Lupus Nephritis/complications , Lupus Nephritis/diagnosis , Lupus Nephritis/immunology , Male , Mexico , Middle Aged , Prospective Studies , Proteinuria/drug therapy , Proteinuria/etiology , Recurrence , Rituximab , Severity of Illness Index , Time Factors , Treatment Failure , Young AdultABSTRACT
BACKGROUND: Pre-diabetic Latino subjects have shown higher incidence of type 2 diabetes mellitus (DM2) compared with other populations. The incidence is unknown in the Mexican population. Our aim was to identify the annual incidence of DM2 among a Mexican pre-diabetic population. METHODS: An inception cohort of healthy Mexican patients was followed from 2001 to 2006. Those who fulfilled diagnosis of DM2 (ADA criteria) were registered at one and 2 years of follow-up among pre-diabetic and normoglucemic individuals. We compared relevant variables between both groups, those who developed diabetes and those who did not. RESULTS: 656 subjects were included; at one year, 14 patients were diagnosed with DM2, 11 among pre-diabetics, incidence of 4.5 %; 3 among normoglucemic subjects, incidence of 0.72 %. The relative risk for the development of DM2 in the pre-diabetic group was 7.7 (IC95 % 2.1-27.9), and among the normoglucemic group of 1.04 (IC95 % 1.02-1.08). At the 2nd year, DM2 incidence was 7.6 % in pre-diabetics, and 0.6 % in normoglucemics. Risk factors associated were higher fast glucose and greater BMI. CONCLUSIONS: We found a constant annual incidence of DM2 among prediabetics of 6 cases per 100 patient/year in follow-up. Higher fast glucose determinations and greater BMI are the main determinants for DM2 development.
