The prognosis of severe lupus nephritis based on the Modification of Diet in Renal Disease (MDRD) Study estimated glomerular filtration rate

Patel, S.; Sm, Korbet; Lewis, EJ

doi:10.1177/0961203310385267

Cited by 15 publications

(9 citation statements)

References 23 publications

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“…Hence, it seems natural that in the field of procedural pulmonary medicine, educators and leaders are advocating the cause of standard procedural curricula and competency assessments [2,3,4,5,6,7,8,9]. Until recently, the bronchoscopic skill of trainees has been subjectively assessed by training program directors, and based in part on the number of procedures performed as well as on watching trainees perform procedures in patients during the course of postgraduate education.…”

Section: Resultsmentioning

confidence: 99%

“…Among pulmonary and critical care physicians, who perform the majority of these procedures for both diagnosis and therapy, a large degree of variation has been demonstrated in the way bronchoscopy is learned by trainees in pulmonary fellowship programs [1,2,3]. Many bronchoscopy educators have therefore advocated the design of standardized curricula in order to teach the knowledge and technical skills necessary for the safe and effective performance of this minimally invasive procedure [2,3,4,5,6,7,8,9]. …”

Section: Background and Rationalementioning

confidence: 99%

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Validation of Two Instruments to Assess Technical Bronchoscopic Skill Using Virtual Reality Simulation

2008

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Background: In an era of increased emphasis on patient safety and competency-based education, demonstration of significant variability in the teaching of flexible bronchoscopy has led to initiatives for new standardized curricula and assessment tools. Objectives: To evaluate the efficacy of such curricula and to assess bronchoscopic skill, 2 measuring instruments have been developed: the Bronchoscopy Skills and Tasks Assessment Tool (BSTAT) and the Bronchoscopy Step-by-Step Evaluation Tool (BSET). We studied the validity and reliability of these 2 instruments. Methods: Two independent testers simultaneously scored 22 volunteer participants at 3 levels [novice (n = 7), fellow (n = 8) and attending (n = 7)] on a virtual reality bronchoscopy simulator using the 2 instruments; each participant was tested twice, in 2 separate sessions. Intertester and test-retest reliability were analyzed with intraclass correlations (ICC); ANOVA was used to assess concurrent validity based on the subjects’ expected skill level. Results: The ICCs between the testers were 0.98 for both the BSTAT and BSET. Comparison of the scores between the sessions showed high test-retest reliability by ICC (0.86 and 0.85 for BSTAT and BSET respectively), with a small yet statistically significant learning effect. The novice group’s scores were lower than the fellows’ and attendings’ (p < 0.001) for both the BSTAT and BSET; the fellows’ scores were consistently lower than the attendings’ on both tests, yet the differences were not statistically significant. Conclusion: This validation study of 2 objective tests of bronchoscopic skill demonstrated high reliability and concurrent validity. These instruments can now be used to evaluate the effectiveness of new competency-based bronchoscopy curricula.

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Section: Resultsmentioning

confidence: 99%

Section: Background and Rationalementioning

confidence: 99%

Validation of Two Instruments to Assess Technical Bronchoscopic Skill Using Virtual Reality Simulation

2008

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“…We included patients with class II and V disease because the diagnoses were made at the beginning of the induction phase with CYC; all of these patients had severe proteinuria and/or decreased eGFR when starting maintenance therapy (data not shown). We estimated renal function in our LN patients by using the MDRD eGFR equation, as recommended by Patel et al [10]. Considering that the role of MF in long-term treatment of severe LN remains unsolved [5], we think our results are useful for clinicians.…”

Section: Discussionmentioning

confidence: 99%

“…Analytical variables included hemoglobin (g/dl), white cell counts (cells/mm 3 ), serum creatinine (mg/dl), estimated glomerular filtration rate (eGFR, ml/min/1.73 m 2 ) calculated using the 4-variable Modification of Diet in Renal Disease (MDRD) equation [eGFR = 175 × serum creatinine - 1.154 × age - 0.203 × 1.210 (if black) × 0.742 (if female)] [10], proteinuria (g/24 h), titers of antinuclear and anti-dsDNA antibody, and levels of complement fractions (C3 and C4, mg/dl). Types and doses of MF (mofetil or sodium), corticosteroids used as maintenance therapy, and antihypertensive drugs were recorded.…”

Section: Methodsmentioning

confidence: 99%

Mycophenolate as Maintenance Therapy for Lupus Nephritis with Impaired Renal Function

et al. 2013

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Background: Mycophenolate (MF) is effective as a maintenance therapy after induction therapy in patients with lupus nephritis (LN). However, little is known about its role in patients with impaired renal function. The purpose of this study was to evaluate the efficacy and safety of MF as a maintenance therapy for LN and its association with renal function. Methods: Data were obtained for 56 Spanish patients who were receiving MF as a maintenance therapy for LN. Patients were classified into two groups according to renal function at the initiation of MF treatment: group 1 [estimated glomerular filtration rate (eGFR) ≥60 ml/min/1.73 m²] and group 2 (eGFR <60 ml/min/1.73 m²). The primary endpoints of the study were the rates of renal relapse and responses, and their relationship with baseline renal function. Secondary outcomes were the appearance of side effects during treatment. Results: At initiation of MF treatment, the only differences between the groups were for age, hemoglobin levels, anti-DNA antibody titer, proteinuria, and renal function. In group 1 (n = 38), the eGFR was 98 ± 34 ml/min/1.73 m² and in group 2 (n = 18) the eGFR was 43 ± 14 ml/min/1.73 m². Only 3 cases had an eGFR <30 ml/min/1.73 m². No significant differences were observed in the rate of relapse at 6 months (group 1: 20%; group 2: 23%) or at 12 months (group 1: 25%; group 2: 17%). Response rates were also similar in both groups. Side effects were unremarkable. Conclusions: MF is effective and safe as a maintenance therapy for LN both in patients with normal renal function and in those with renal impairment.

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“…We have not chosen serum creatinine as a marker of renal function since 8% of the patients with normal serum values (<1.2 mg/dl) have decreased eGFR. Patel et al [12] demonstrated that renal function in LN should be measured using eGFR rather than serum creatinine alone. …”

Section: Discussionmentioning

confidence: 99%

Mycophenolate as Induction Therapy in Lupus Nephritis with Renal Function Impairment

Rivera

Fulladosa²,

Poveda³

et al. 2012

Am J Nephrol

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Background: Mycophenolate (MF) is effective as induction therapy for lupus nephritis (LN) in patients with normal renal function; however, little is known about its role in patients with impaired renal failure. The purpose of this study was to evaluate the response to MF in LN and its association with baseline renal function. Methods: Data were obtained for 90 patients from 12 Spanish renal units who were receiving MF as induction therapy for LN. Patients were classified into 2 groups: group 1 (estimated glomerular filtration rate [eGFR] ≥60 ml/min/1.73 m²) and group 2 (eGFR <60 ml/min/ 1.73 m²). The primary outcome measure was the percentage of patients who achieved any response and its relationship with initial eGFR. The secondary outcome measures were the percentage of patients who achieved a complete response (CR) or partial response (PR) and the appearance of relapses during treatment and side effects. Results: At initiation of MF treatment, there were no differences in the main parameters between group 1 (n = 63; eGFR 87 ± 23 ml/min/ 1.73 m²) and group 2 (n = 27; eGFR 44 ± 12 ml/min/1.73 m²). Exposure to prednisone and MF was similar. The percentages of patients who achieved a response in groups 1 and 2 were, respectively, 69.2 and 43.8% at 6 months and 81.3 and 73.7% at 12 months. CR was more frequent in group 1, whereas PR was similar in both groups. Four patients relapsed and side effects were unremarkable. Conclusions: MF is effective and safe as induction therapy for LN, and response is even achieved in patients with baseline renal impairment.

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The prognosis of severe lupus nephritis based on the Modification of Diet in Renal Disease (MDRD) Study estimated glomerular filtration rate

Cited by 15 publications

References 23 publications

Validation of Two Instruments to Assess Technical Bronchoscopic Skill Using Virtual Reality Simulation

Validation of Two Instruments to Assess Technical Bronchoscopic Skill Using Virtual Reality Simulation

Mycophenolate as Maintenance Therapy for Lupus Nephritis with Impaired Renal Function

Mycophenolate as Induction Therapy in Lupus Nephritis with Renal Function Impairment

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