Outcomes in maintenance therapy of lupus nephritis at an interdisciplinary rheumatology and nephrology service at a mixed population tertiary care center

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Frieda Wolf

Emek Medical Center, Afula, Israel

: J Nephrol Ren Dis

Abstract

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Systemic Lupus Erythematosus (SLE) affects approximately between 1500 to 5000 people in Israel, 90% of who are women. Emek Medical Center in Afula, Israel, serves about 1.3 million, a mixed population of Jews, Muslims and Christians. 195 patients with SLE have been treated at our center, 70 with kidney involvement. We have established a service combining rheumatologic and nephrologic care for these patients. We compared outcomes in those receiving newer maintenance therapies (MMF +steroids +plaquenil) to older maintenance therapy (Imuran +steroids+plaquenil). Using the electronic medical record, we identified 28 patients with active lupus nephritis on maintenance therapy. There were 22 women (78.6%) and 6 men, average age was 29.2 years. 78.6% spoke Arabic as their primary language and 21.4% spoke Hebrew. Of the 28, 16 were treated with azathioprine and 12 with MMF maintenance therapy. We compared renal outcomes,(increasing serum creatinine, proteinuria, ESRD, number of admissions, mortality, side effects of medications, sequelae of disease or medication use) of these two groups. We also compared disease activity using SLEDAI criteria, anti-DSDNA and complement levels. Of these 28 patients, 25 were also receiving steroids, 25 were on plaquenil. 13 received ACEI and 7 had angiotensin receptor blockers. There was no difference in outcome between the two groups. Both showed improved SLEDAI score, improved complement levels and decrease in DSDNA titers, decreased protein excretion and improved albumin level. Creatinine levels did not increase, and none progressed to ESRD. We conclude there is no difference in outcomes in maintenance therapy with Imuran versus MMF. Emek Medical Center is located in Afula in the Jezreel valley, and serves the 1.3 million inhabitants of the Jezreel valley and the lower Galilee.

Biography

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Frieda Wolf, MD graduated from medical school at Technion in Haifa, Israel in 1998. She trained in internal medicine and nephrology and transplant medicine at Downstate Medical Center in New York, USA, and served as an Assistant Professor of Medicine at SUNY Downstate until 2008. In 2009 she relocated to Israel, and currently works as nephrologist and internist at Emek Medical Center. Her research interests include outcomes in lupus nephritis and magnesium abnormalities.