scholarly journals Evaluation of Treatment Response in Lupus Nephritis

2021 ◽  
Vol 28 (4) ◽  
pp. 389-395
Author(s):  
Anca BOBIRCA ◽  
◽  
Florin BOBIRCA ◽  
Anca FLORESCU ◽  
Carmen IORGUS ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Induction Therapy ◽  
Clinical Laboratory ◽  
Laboratory Data ◽  
Complete Response ◽  
Response To Therapy ◽  
Treatment Regimens ◽  
Rate Of Response ◽  
Risk Of Relapse

Objectives: To evaluate the effectiveness of the treatment reflected by the rate of response to therapy at 6 months and 12 months of follow-up respectively. Methods: We retrospectively analyzed clinical, laboratory data, treatment regimens, the type of response and relapse rate of 51 patients diagnosed with LN between January 2017 and February 2020. Results:47.06% of the patients underwent renal biopsy, classes III and IV being the most common lupus nephritis types (totaling 35.3% of biopsied patients). All induction therapy choices analyzed in the study- CYC, Glucocorticoids (GCs) and MMF- proved effective at reducing the proteinuria of the patients (p=0.001, p=0.012 and p=0,019 respectively. The 12 months evaluation demonstrated an ascending trend of the complete response, starting from 27.45% at 6 months and almost doubling at 1 year (56.86%). Almost half of patients (49.02%) did not relapse, while most of them (27.45%) had only 1 relapse. Analyzing the risk of relapse for each induction drug used, CYC had the highest rate of recurrence (62.07%). The use of MMF as a maintenance drug associated the lowest degree of recurrence. Conclusions: Both CYC and MMF as induction therapy are significantly effective in reducing proteinuria. The complete response was more frequently identified as an endpoint at 12 months of follow-up.

Impact of stringent response in proteinuria on long-term renal outcomes in proliferative lupus nephritis

Lupus ◽  
2019 ◽  
Vol 28 (11) ◽  
pp. 1294-1301 ◽  
Author(s):  
J Won ◽  
J S Lee ◽  
J S Oh ◽  
Y-G Kim ◽  
C-K Lee ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Induction Therapy ◽  
Lower Risk ◽  
Clinical Laboratory ◽  
Laboratory Data ◽  
Class Iii ◽  
Renal Outcomes ◽  
Renal Flare ◽  
Proliferative Lupus Nephritis

Objectives Favourable long-term prognosis in proliferative lupus nephritis (LN) is associated with the achievement of complete renal response (CR), which is defined as a urine protein/creatinine ratio (UPCR) of < 0.5. However, it is unclear whether a more stringent cut-off for proteinuria (normal value of proteinuria; UPCR < 0.15) is better than CR. We aimed to evaluate the effect of stringent CR, defined as a UPCR of <0.15, on long-term renal outcomes in proliferative LN. Methods We included 87 patients with class III or IV LN who achieved CR at one year after induction therapy. Clinical and laboratory data were compared between the stringent and non-stringent CR groups. Logistic regression analysis was performed to identify factors associated with achievement of stringent CR. Cox analysis was performed to analyse the risk factors for renal flare and development of chronic kidney disease (CKD). Results The stringent and non-stringent CR groups included 58 and 29 patients, respectively. The two groups showed no significant baseline differences in terms of the clinical, laboratory and pathological classification. The sustained CR rates during five years were 91.3% and 50.0% ( p = 0.014) in the stringent and non-stringent CR groups, respectively. In Cox analyses, the achievement of stringent CR was associated with a lower risk of five-year renal flare rate (hazard ratio (HR) = 0.161, 95% confidence interval (CI) 0.063–0.411, p < 0.01) and development of CKD (HR = 0.189, 95% CI 0.047–0.752, p = 0.018). Mycophenolate mofetil induction therapy was associated with achievement of stringent CR at a borderline level of significance (HR = 7.268, 95% CI 0.894–59.089, p = 0.064). Conclusion Achievement of stringent CR predicted lower risk of renal flare and development of CKD in proliferative LN. These findings suggest that stringent CR is a valuable treatment target in proliferative LN.

scholarly journals Differences in rituximab use between pediatric rheumatologists and nephrologists for the treatment of refractory lupus nephritis and renal flare in childhood-onset SLE

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Mileka Gilbert ◽  
Beatrice Goilav ◽  
Joyce J. Hsu ◽  
Paul J. Nietert ◽  
Esra Meidan ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Induction Therapy ◽  
Pediatric Nephrology ◽  
Response To Treatment ◽  
Individual Treatment ◽  
Induction Treatment ◽  
Childhood Onset ◽  
Renal Flare ◽  
Treatment Plans

Abstract Background Consensus treatment plans have been developed for induction therapy of newly diagnosed proliferative lupus nephritis (LN) in childhood-onset systemic lupus erythematosus. However, patients who do not respond to initial therapy, or who develop renal flare after remission, warrant escalation of treatment. Our objective was to assess current practices of pediatric nephrologists and rheumatologists in North America in treatment of refractory proliferative LN and flare. Methods Members of Childhood Arthritis and Rheumatology Research Alliance (CARRA) and the American Society for Pediatric Nephrology (ASPN) were surveyed in November 2015 to assess therapy choices (other than modifying steroid dosing) and level of agreement between rheumatologists and nephrologists for proliferative LN patients. Two cases were presented: (1) refractory disease after induction treatment with corticosteroid and cyclophosphamide (CYC) and (2) nephritis flare after initial response to treatment. Survey respondents chose treatments for three follow up scenarios for each case that varied by severity of presentation. Treatment options included CYC, mycophenolate mofetil (MMF), rituximab (RTX), and others, alone or in combination. Results Seventy-six respondents from ASPN and foty-one respondents from CARRA represented approximately 15 % of the eligible members from each organization. Treatment choices between nephrologists and rheumatologists were highly variable and received greater than 50 % agreement for an individual treatment choice in only the following 2 of 6 follow up scenarios: 59 % of nephrologists, but only 38 % of rheumatologists, chose increasing dose of MMF in the case of LN refractory to induction therapy with proteinuria, hematuria, and improved serum creatinine. In a follow up scenario showing severe renal flare after achieving remission with induction therapy, 58 % of rheumatologists chose CYC and RTX combination therapy, whereas the top choice for nephrologists (43 %) was CYC alone. Rheumatologists in comparison to nephrologists chose more therapy options that contained RTX in all follow up scenarios except one (p < 0.05). Conclusions Therapy choices for pediatric rheumatologists and nephrologists in the treatment of refractory LN or LN flare were highly variable with rheumatologists more often choosing rituximab. Further investigation is necessary to delineate the reasons behind this finding. This study highlights the importance of collaborative efforts in developing consensus treatment plans for pediatric LN.

scholarly journals Comparing the Efficacy and Safety of Induction Therapies for the Treatment of Patients with Proliferative Lupus Nephritis in South Africa

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Phelisa Sogayise ◽  
Udeme Ekrikpo ◽  
Ayanda Gcelu ◽  
Bianca Davidson ◽  
Nicola Wearne ◽  
...  
Keyword(s):  
South Africa ◽  
Lupus Nephritis ◽  
Induction Therapy ◽  
Randomized Study ◽  
Induction Treatment ◽  
Limited Data ◽  
Proliferative Lupus Nephritis ◽  
Significant Difference ◽  
Kidney Replacement Therapy

Background. Lupus nephritis (LN) can be complicated with requirement for kidney replacement therapy and death. Efficacy of induction therapies using mycophenolate mofetil (MMF) or intravenous cyclophosphamide (IVCYC) has been reported from studies, but there is limited data in Africans comparing both treatments in patients with proliferative LN. Methods. This was a retrospective study of patients with biopsy-proven proliferative LN diagnosed and treated with either MMF or IVCYC in a single centre in Cape Town, South Africa, over a 5-year period. The primary outcome was attaining complete remission after completion of induction therapy. Results. Of the 84 patients included, mean age was 29.6 ± 10.4 years and there was a female preponderance (88.1%). At baseline, there were significant differences in estimated glomerular filtration rate (eGFR) and presence of glomerular crescents between both groups ( p ≤ 0.05 ). After completion of induction therapy, there was no significant difference in remission status (76.0% versus 87.5%; p = 0.33 ) or relapse status (8.1% versus 10.3%; p = 0.22 ) for the IVCYC and MMF groups, respectively. Mortality rate for the IVCYC group was 5.5 per 10,000 person-days of follow-up compared to 1.5 per 10,000 person-days of follow-up for the MMF group ( p = 0.11 ), and there was no significant difference in infection-related adverse events between both groups. Estimated GFR at baseline was the only predictor of death (OR: 1.0 [0.9–1.0]; p = 0.001 ). Conclusion. This study shows similar outcomes following induction treatment with MMF or IVCYC in patients with biopsy-proven proliferative LN in South Africa. However, a prospective and randomized study is needed to adequately assess these outcomes.

scholarly journals P0429OUTCOMES OF LUPUS NEPHRITIS OVER AN ERA OF EVOLVING IMMUNOSUPPRESSION

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Jason McMinn ◽  
Colin C Geddes ◽  
Emily McQuarrie
Keyword(s):  
Lupus Nephritis ◽  
Electronic Patient Record ◽  
Immunosuppressive Treatment ◽  
Complete Response ◽  
Histopathological Diagnosis ◽  
Class V ◽  
Remission Rates ◽  
Induction Regimen ◽  
Before And After

Abstract Background and Aims The reported incidence of lupus nephritis (LN) is approximately 6.1 cases per million population per year in Scotland based on Scottish Renal Registry biopsy data. Despite immunosuppressive treatment, approximately 10-30% of patients will progress to established renal failure (ERF) within 15 years. In December 2007, our unit moved from a protocol of Cyclophosphamide/ steroid induction with Azathioprine/ Prednisolone maintenance to Mycophenolate/ steroid induction and maintenance. We undertook this study to compare remission rates before and after this change. Method A retrospective electronic patient record analysis was performed for all patients in our centre with a documented native renal biopsy showing a histopathological diagnosis of LN, between 1 July 1993 and 31 December 2017. Repeat biopsies were excluded. Baseline demographics, histopathological class and first and second line induction and maintenance therapies were recorded. Endpoints analysed were; partial and complete response (as defined in KDIGO Clinical Practice Guideline for Glomerulonephritis 2012), time to achieve this response, relapse, progression to ERF and death. Results 120 patients who underwent a biopsy during the 24.5-year period received a diagnosis of lupus nephritis. 82.5% of patients were Caucasian. Median duration of follow-up was 72 months. 15% of patients died and 5% developed ERF within the follow-up period, representing one death per 56 patient years and one incident case of ERF per 168 patient years. There were 40 patients in the pre-December 2007 group and 80 in the post-December 2007 group. Those in the earlier group were younger, with a mean age of 35.4 years versus 44.8 years in the later group (p=0.002). 23% had class V in the earlier group compared to 15% in the later group (p=0.31). Proportions of female patients were 80% and 75% in the early and late groups respectively (p=0.54). Median creatinine was 106µmol/L in the pre-December 2007 group and 89.5 µmol/L in the post-December 2007 group (p=0.96). Patients in the pre- and post- December 2007 groups had comparable rates of complete response, at 72% and 71% respectively. However, those diagnosed before December 2007 were slower to respond, with a median time to achieve complete response of 10.5 months, compared to 6 months in those diagnosed after 1 December 2007 (p=0.007). Conclusion Following a change in our immunosuppressive induction regimen from Cyclophosphamide/ steroids to Mycophenolate/ steroids, our response rates have remained similar, however speed of attaining remission has improved.

scholarly journals Urine TWEAK level as a biomarker for early response to treatment in active lupus nephritis: a prospective multicentre study

2019 ◽  
Vol 6 (1) ◽  
pp. e000298 ◽  
Author(s):  
Thitima Benjachat Suttichet ◽  
Wonngarm Kittanamongkolchai ◽  
Chutipha Phromjeen ◽  
Sirirat Anutrakulchai ◽  
Thanachai Panaput ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Treatment Response ◽  
Induction Therapy ◽  
Characteristic Curve ◽  
Predictive Performance ◽  
Complete Response ◽  
Early Response ◽  
Response To Treatment ◽  
Urine Protein ◽  
Spot Urine

BackgroundTNF-like weak inducer of apoptosis (TWEAK) is a proinflammatory molecule that plays a key role in active inflammation of lupus nephritis (LN). Urine TWEAK (uTWEAK) levels were found to be associated with renal disease activity among patients with LN. Here, we determined whether serial measurements of uTWEAK during induction therapy could predict treatment response or not.MethodsSpot urine samples were collected from patients with biopsy-proven active LN at time of flare, and 3 and 6 months after flare to assess the uTWEAK levels. All patients received standard immunosuppressive therapy and treatment response was evaluated at 6 months. The performance of uTWEAK as a predictor for treatment response was compared with clinically used biomarkers for patients with LN.ResultsAmong 110 patients with LN, there were 29% complete responders (CR), 34% partial responders (PR) and 37% non-responders (NR). On average, uTWEAK level was consistently low in CR, trended down by 3 months in PR and persistently elevated in NR. uTWEAK levels at month 3 were able to predict complete response at month 6 (OR adjusted for age, sex and creatinine=0.34 [95% CI 0.15 to 0.80], the area under the receiver operating characteristic curve [ROC-AUC]=0.68, p=0.02). The optimal threshold for uTWEAK level at month 3 was 0.46 pg/mgCr, discriminating complete response with 70% sensitivity and 63% specificity. Combining uTWEAK and urine protein at month 3 improved predictive performance for complete response at 6 months (ROC-AUC 0.83, p<0.001).ConclusionsIn addition to urine protein, uTWEAK level at 3 months after flare can improve the accuracy in predicting complete response at 6 months of induction therapy.

Long-term follow-up of patients with good-risk germ cell tumors treated with etoposide and cisplatin.

1997 ◽  
Vol 15 (7) ◽  
pp. 2553-2558 ◽  
Author(s):  
H Xiao ◽  
M Mazumdar ◽  
D F Bajorin ◽  
M Sarosdy ◽  
V Vlamis ◽  
...  
Keyword(s):  
Germ Cell ◽  
Salvage Therapy ◽  
Germ Cell Tumors ◽  
Complete Response ◽  
Response To Therapy ◽  
Survival Status ◽  
Long Term Follow Up ◽  
Time To Relapse ◽  
Good Risk

PURPOSE To assess the durability of response and overall survival for patients with good-risk metastatic germ cell tumors (GCT) treated with four cycles of etoposide and cisplatin (EP). PATIENTS AND METHODS Two hundred fourteen patients treated with EP on two consecutive randomized trials for good-risk metastatic GCT were the subject of this retrospective study. The response to therapy, relapse and survival status, and results of salvage therapy are reported. RESULTS One hundred ninety-five patients (91%) achieved a complete response (CR). This included 182 patients (85%) who achieved a CR to chemotherapy alone and 13 patients (6%) who achieved a CR to chemotherapy plus surgical resection of viable GCT. Seventeen patients (9%) have relapsed from CR. The median time to relapse was 10 months, and the longest duration from treatment to relapse was 36 months in a patient who received three of four planned courses of therapy. Eight patients who either achieved an incomplete response (IR) or relapsed were rendered continuously disease-free by salvage therapy and are alive. One hundred eighty-three patients (86%) are alive at a median follow-up of 7.6 years. CONCLUSION Four cycles of EP constitute effective therapy and can be offered to patients with good-risk GCT. In patients with intermediate- and poor-risk GCT, clinical trials remain a priority to identify more effective treatment.

Response to Therapy with Imatinib Mesylate in Patients with CML Is Poor in Non-Caucasian Patients.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 2937-2937
Author(s):  
Sarah George ◽  
Laura Horvath ◽  
Robert Molokie ◽  
John Berry ◽  
Damiano Rondelli ◽  
...  
Keyword(s):  
Imatinib Mesylate ◽  
Philadelphia Chromosome ◽  
Chronic Phase ◽  
Response Rates ◽  
Complete Response ◽  
Response To Therapy ◽  
Low Risk ◽  
Risk Scores ◽  
Genetic Characteristics

Abstract Imatinib mesylate is a targeted therapy for chronic myeloid leukemia (CML). All phases of CML are susceptible to imatinib, with more durable responses occurring in patients in chronic phase. Studies in patients with chronic phase CML who have been treated with imatinib have shown a complete hematologic remission (CHR) rate of 97%, a complete cytogenetic remission (CCR) rate of 70%, and a complete molecular remission (CMR) rate of 10%. Racial and ethnic differences have not been extensively studied in relation to cancer outcomes, and no studies to date have demonstrated a difference in outcomes based upon race or ethnicity of patients with CML treated with imatinib. Methods : A retrospective chart review of patients with CML who have been treated with imatinib at the University of Illinois, the Westside VA, and MacNeal hospitals over the past 3 years was performed. Primary endpoints were rates of CHR, CCR, and CMR in Caucasian (C) and non-Caucasian (NC) patients with CML on treatment with imatinib. A secondary endpoint was the correlation of Sokal scores at initiation of imatinib with rates of CHR, CCR, and CMR. Results: 26 charts were reviewed of 7 C and 19 NC patients ( 12 African American, 5 Latino, 1 Indian, 1 Lebanese) in chronic phase CML. For C patients at the initiation of imatinib, mean age was 46 (45 for NC) and mean Sokal score was 0.79 (0.75 for NC). 32% (8/25) of patients had cytogenetic abnormalities in addition to the Philadelphia chromosome, all of whom were NC (50% were pretreated; 29% obtained CCR). Mean duration from diagnosis to treatment with imatinib was 5 months for C and 9 months for NC. Mean length of follow up while on imatinib was 28 months for C and 14 months for NC, with early termination due to lack of follow up, progression of disease, and death. 31% (8/26) of patients (25% C, 75% NC) had received prior treatments with agents such as IFN, AraC, busulfan, anagrelide, homoharrington, and allogeneic SCT. 100% of pretreated C had CCR (vs 33% of pretreated NC). CHR rate was 100% in C (4/4) vs. 87.5% (14/16) in NC. CCR was obtained in 100% of C (6/6) but only 14% (2/14) of NC. CMR rate was noted to be 33% (1/3) in Caucasians compared to 8.3% (1/12) in NC. Low risk Sokal scores were associated with CHR rate of 100% in C (3/3) and 75% (6/8) in NC, as well as CCR rate of 100% in C (5/5) and only 25% (2/8) in NC. Conclusions: NC patients have a poorer response to treatment with imatinib for CML. The discrepancy between complete response rates (most notably the CCR rate) between C and NC patients could be accounted for by differences in the genetic characteristics of the disease, metabolism, or adherence rates. NC patients with low risk Sokal scores also had poorer complete response rates than C patients with the same risk scores. Prospective studies are needed to further evaluate these differences and discern their etiology. Given poor CCR rates, NC patients should be HLA typed soon after diagnosis and considered for transplant if a matched donor is available.

A Retrospective Hospital Based Study of 440 Patients of Aplastic Anemia from India: Epidemiology; Response to Therapy; and Possible Significance of Jaundice during Therapy.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 5299-5299 ◽  
Author(s):  
Rajat Kumar ◽  
Dharma R. Choudhary ◽  
Manoranjan Mahapatra ◽  
Atul Kotwal ◽  
Alka Mathur ◽  
...  
Keyword(s):  
Aplastic Anemia ◽  
Statistical Significance ◽  
Medical Science ◽  
Specific Treatment ◽  
Complete Response ◽  
Response To Therapy ◽  
Acute Leukemias ◽  
Overall Response ◽  
High Incidence

Abstract All new cases of aplastic anemia (AA) seen in the Hematology out patient department (OPD) of All India Institute of Medical Science (AIIMS) from January 2001 to December 2003 were studied till last follow up. Complete response (CR) was defined as - normalization of blood counts; Partial response (PR) as - improvement in blood counts, transfusion independence and not meeting criteria of CR. Database was created in MS Access and SPSS ver 11 was used for statistical analysis. Descriptive statistics were calculated and appropriate tests of significance carried out. Result- A total of 440 cases of AA were seen during the study period. The total number of new hematology patients seen in the same period was 8605; thus AA comprised 51.13 per thousand (95% CI, 37.9–67.1) new hematology cases. The number of acute leukemias (AML and ALL) diagnosed during this period was 392: the ratio of AA to acute leukemia was 1.1:1. The total number of OPD patients registered in AIIMS for these 3 years was 43,04,849. Thus AA patients comprised 102.23 per million (95% CI, 83.2–123.8) hospital OPD patients. This very high incidence of AA may be due to the tertiary nature of AIIMS. The median age at presentation was 19yr (range 2–84), with males 311 (71%) and females 129 (29%). At presentation the hematological values were: mean hemoglobin (Hb) 5.2 ± 2.03 g/dl; mean total leucocyte count (TLC) 3.1 ± 1.3 x 109/L, mean platelet counts 33.8 ± 19.5 x 109/L. Follow up period was for a median of 3 months (range 0–42). Specific treatment consisted of (a) Androgens - Stanozolol at 2 mg/kg/d (b) Cyclosporine at 3mg/kg/d (c) Antithymocyte globulin at total dose of 75–80mg/kg over 5 to 8 days and (d) combinations of these drugs. The following subgroups were excluded from analysis (i) 14 (3.1%) patients whose records were incomplete and (ii) 38 (8.6%) patients who received only supportive therapy with no response, but whose individual follow up was limited. The overall response to all therapies was 29.7%. The response to different subgroups and statistical significance is given in Table. Jaundice occurred in 23 (5.2%) patients during treatment and HBsAg was positive in two. The course of jaundice was clinically uncomplicated and lasted for 2 to 3 weeks. An interesting finding was a partial or complete response to therapy in 19/23 (82.6%) with CR in 47.8% and PR in 34.8%. The difference in response rate of those who developed jaundice while on therapy and those who did not was statistically significant (P=0.000). Conclusions: The high incidence of AA in India provides a potential for future studies regarding its etiopathogenesis and therapy. Economic limitations make Stanozolol an important drug in developing countries with its response rates of 19.7%. The unexpected high response in those who developed jaundice during therapy suggests that this could be a marker for recovery. Response§ to Different Therapies in 388 Patients of Aplastic Anemia Treatment group Androgen alone Cyclosporin alone Androgen and Cyclosporin ATG + Cyclosporin ±Androgen Test Chi square test. ©Not statistically significant. ®Statistically significant. §Response compared to overall response to other therapies. Total number (%) 172 (39.1) 13 (3) 179 (40.7) 24 (6.3) Overall response, % 19.7 8.3 31.2 62.5 PR, % 8.6 8.3 15.9 33.3 CR, % 11.1 0 15.3 29.2 P value 0.067© not done 0.083© 0.000®

Fever after anti-programmed cell death-1 treatment to predict the response in advanced hepatocellular carcinoma.

2018 ◽  
Vol 36 (5_suppl) ◽  
pp. 90-90 ◽  
Author(s):  
San-Chi Chen
Keyword(s):  
Cell Death ◽  
Programmed Cell Death ◽  
Partial Response ◽  
Tumor Lysis Syndrome ◽  
Laboratory Data ◽  
Complete Response ◽  
Advanced Hepatocellular Carcinoma ◽  
Sorafenib Treatment ◽  
Tumor Lysis

90 Background: Anti-programmed cell death (PD)-1, an immune checkpoint inhibitor, has been recently approved for the treatment of patients with HCC following prior sorafenib. However, a reliable predictor of treatment response has not been established. Patients who experienced immune-related adverse events (irAEs) of any grade yielded a significantly higher response rate than did those did not experience irAEs. Methods: Three cases of advanced HCC with or without previous sorafenib treatment, underwent anti-PD-1 treatment (pembrolizumab, 2 mg/kg, at 3-week interval) with or without combination of sorafenib (400mg daily). Results: Case 1 Fever (38.3°C) developed 2 days after anti-PD-1 treatment. The fever persisted for 2 months and gradually subsided (Figure 2B). Follow-up computed tomography (CT) revealed persistent tumor shrinkage and complete response at the latest time of examination (Figure 1B); the treatment is ongoing. Case 2 Spiking fever developed after each time of anti-PD-1 treatment. Follow-up CT revealed a remarkable decrease in the tumor size (3 cm), resulting in a partial response (Figure 1D); the treatment is ongoing. Case 3 Twelve days after the treatment, the patient complained of fever and general weakness. Laboratory data revealed tumor lysis syndrome and disseminated intravascular coagulopathy (DIC). HBV, hepatitis B virus; HCV, hepatitis C virus; BCLC, Barcelona Clinic Liver Cancer; AFP, alpha-fetoprotein; TACE, transarterial chemoembolization; CR, complete response; PR, partial response. Conclusions: Fever may be an early predictor of response to anti-PD-1 treatment. The degree of fever seemed to be correlated with tumor burden. High fever may suggest cytokine storm and possible tumor lysis syndrome. Early detection is necessary for the immediate prescription of steroids and management of tumor lysis.[Table: see text]

scholarly journals Repeated Renal Biopsy - A Predictive Tool to Assess the Probability of Renal Flare in Lupus Nephritis

2016 ◽  
Vol 44 (6) ◽  
pp. 439-446 ◽  
Author(s):  
Gastón J. Piñeiro ◽  
Pilar Arrizabalaga ◽  
Manel Solé ◽  
Rosa M. Abellana ◽  
Gerard Espinosa ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Renal Biopsy ◽  
Clinical Laboratory ◽  
Predictive Tool ◽  
Renal Flare ◽  
Therapeutic Decisions ◽  
The Mean ◽  
Mean Time

Background: How one responds to treatment of lupus nephritis (LN) is based on clinical features, but the activity in renal biopsy (RB) is uncertain. We have described the therapeutic decisions after performing a repeated RB on the assessment of response to intravenous cyclophosphamide (IC) and the possible prognostic role of this repeated RB. Methods: Clinical, laboratory and histological features at the initial RB and repeated RB were analyzed in 35 patients. Results: Data in the initial versus the repeated RB were serum creatinine 1.23 ± 1.08 and 0.96 ± 0.45 mg/dl (p < 0.05), glomerular filtration rate <60 ml/min in 12 and 5% patients and proteinuria 4.1 ± 2.8 vs. 0.6 1.1 g/day (p < 0.05). Significant differences were detected in hematuria, nephrotic syndrome and serological immune features. Complete renal remission was reached in 60% (n = 21) at the time of the repeated RB, partial remission in 31.4% (n = 11), and no response IC in 8.6% (n = 3). Nine patients showed proliferative forms in the repeated RB, 3 of them had proteinuria <1 g/day. Just after the repeated RB, 34.3% increased or started a new immunosuppressive therapy, 17.1% remained with the same complementary IST, and 14.3% decreased or stopped it. In the follow-up post repeated RB, 34.5% without active lesions showed a renal flare versus 77.8% with active lesions (p = 0.04). The mean time was 120 and 45 months, respectively. Conclusion: A repeated biopsy in LN distinguishes patients in true remission from those in apparent remission. By doing this, we can identify patients who could benefit from intensified treatment and for whom unnecessary treatment methods can be modified or eliminated.

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