Prognosis After Immunosuppression of Patients With Crescentic Nephritis Requiring Dialysis

Hind, C. R. K.; Lockwood, C. M.; Peters, D. K.; Paraskevakou, Helen; Evans, David J.; Rees, A.

doi:10.1016/s0140-6736(83)91685-9

Cited by 83 publications

(26 citation statements)

References 15 publications

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“…In three British series published in the mid 1980s, only 15 of 132 patients (I 1 %) were aged over 70 years,'"3 and in some series no patient was aged over 70 years. 4 TREATMENT AND OUTCOME Table 2 shows induction immunosuppression given in the first three months, together with outcome at three months and latest follow-up. Actual patient survival is shown in the figure.…”

Section: Discussionmentioning

confidence: 99%

Vasculitis and rapidly progressive glomerulonephritis in the elderly

Higgins

Goldsmith

Connolly

et al. 1996

Postgraduate Medical Journal

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SummaryThe proportion of patients with vasculitis and rapidly progressive nephritis aged 70 years or over has risen from about 10% in the 1980s to over 30% in series reported in the 1990s. This study was undertaken to examine the presentation and outcome of such older patients. Seventeen of 56 patients (30%) who presented at two renal units were aged 70 years or over. Mean creatinine level at presentation was 530 ytmol/l, and five patients received dialysis at presentation. Outcome was dependent on three factors, namely comorbid pathology, response to immunosuppressive therapy, and the occurrence in three cases of temporary spontaneous partial remission. Overall patient survival at one and two years was 62.5% and 50%, respectively, and 90% and 100% of surviving patients were independent of dialysis at one and two years, respectively. Response to chemotherapy was excellent, with full rehabilitation in many cases and no deaths directly attributable to adverse effects of immunosuppressive therapy. We conclude that diagnosis ofvasculitis and rapidly progressive glomerulonephritis by renal biopsy and the subsequent administration of chemotherapy (including cyclophosphamide in many cases) resulted in a worthwhile benefit in these elderly patients.

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Section: Discussionmentioning

confidence: 99%

Vasculitis and rapidly progressive glomerulonephritis in the elderly

Higgins

Goldsmith

Connolly

et al. 1996

Postgraduate Medical Journal

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“…When the disease is not controlled by these measures, plasmapheresis has been advocated. It may be of particular value when the patient is oliguric (Hind et al 1983). Without plasmapheresis, very few anuric patients have recovered renal function.…”

Section: Diagnosismentioning

confidence: 99%

“…In such patients, if there is no sign of recovery after 3-4 weeks, immunosuppressive treatment should be reserved for controlling extrarenal vasculitis. Combined immunosuppression and plasmapheresis is associated with a high mortality from infection (Hind et al 1983).…”

Section: Diagnosismentioning

confidence: 99%

Renal Vasculitis: A Review

Neild

1985

J R Soc Med

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“…Our experience is that recovery can be achieved in almost all patients who still retain renal function at pre sentation [6], Application of this therapeutic approach to the RPGN associated with systemic vasculitides, such as Wegener's granulomatosis (WG) and microscopic polyarteritis (MP), was on an empirical basis initially, since the patho genesis of these disorders was unknown. Striking re sponses, even in patients who were dialysis dependent [7], encouraged us to carry out a randomised prospective con trolled trial (in which at entry the patients were stratified for level of renal function) to test whether plasma ex change enhanced the benefit carried by drug therapy alone. Results showed that the addition of plasma ex change to drug treatment was of significant benefit to the group of patients with the most advanced renal impair ment (dialysis dependent) [6; Pusey et al, in preparation] and provided a clue that humoral mechanisms might be important in pathogenesis.…”

Section: Introductionmentioning

confidence: 99%