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Revista HUGV 2010 - Hospital Universitário Getúlio Vargas - Ufam

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EVOLUÇÃO DE PACIENTES COM NEFRITE LÚPICA TRATADOS COM CICLOFOSFAMIDA<br />

Observou-se, ainda, que foi necessária<br />

menor dose de corticoide após a pulsoterapia com<br />

ciclofosfamida.<br />

A falha terapêutica se deu em 37,9% da amostra.<br />

Segundo alguns autores, perto de 20% dos pacientes<br />

não alcançarão remissão renal, utilizando-se os<br />

esquemas atualmente disponíveis. 5 A azatioprina foi<br />

o tratamento de manutenção mais utilizado (51,7%),<br />

seguida pelo micofenolato de mofetil (6,9%).<br />

CONCLUSÃO<br />

Observa-se, portanto, melhora no perfil clínico<br />

e laboratorial da maior parte dos pacientes que<br />

realizaram pulsoterapia para tratamento da nefrite<br />

lúpica grave, mostrando ser uma forma efetiva<br />

de alcançar remissão da atividade renal, prevenir<br />

reativações renais e prevenir ou interromper a<br />

perda crônica da função renal. Em razão de sua<br />

toxicidade e eventuais falhas terapêuticas, porém,<br />

novos esquemas terapêuticos devem ser avaliados.<br />

REFERÊNCIAS<br />

1. Rothfield NF. Systemic lupus erythematosus: clinical<br />

aspects and treatment. In: Apud, McCarty DJ, Koopman WJ,<br />

editors. Arthritis and allied conditions. 12. ed. Philadelphia:<br />

Lea & Febiger. 1993. p. 1.155-1.177.<br />

2. Sato EI, Bonfá ED, Costallat LTL, Silva NA, Brenol<br />

JNT, Santiago MB, Szajubok JCM, et al. Consenso Brasileiro<br />

para o Tratamento do Lúpus Eritematoso Sistêmico (LES).<br />

<strong>Revista</strong> Brasileira de Reumatologia. 2002; 42(6).<br />

3. Lahita RG. Clinical presentation of systemic lupus<br />

erythematosus. In: Kelley WN, Harris ED, Ruddy S, Sledge<br />

CB, editors. Textbook of rheumatology. 5.ed. Philadelphia:<br />

Copyright. 1997. v. 2. p. 1028-39.<br />

4. Balow JE. Renal manifestations of systemic<br />

lupus erythematosus and other rheumatic disorders. In:<br />

Gereendberg A, editor. Primer on kidney diseases. 2d ed. San<br />

Diego: Copyright; 1998. p. 208-15.<br />

5. Cameron JS. Lupus nephritis. J Am Soc Nephrol.<br />

1999; 10: 413-24.<br />

6. Rosner S, Ginzler EM, Diamond HS, Weiner M, Fries<br />

JF, Wasner C. A multicenter study of outcome in systemic lupus<br />

erythematosus. II. Causes of death. Arthritis Rheum. 1982; 25: 612-7.<br />

7. Balow JE, Decker JL. Mortality in lupus nephritis.<br />

Arthritis Rheum. 1979; 22: 764-9.<br />

8. Weening JJ, D’Agati VD, Schwartz MM. International<br />

Society of Nephrology Working Group on the Classification of<br />

Lupus Nephritis; Renal Pathology Society Working Group on<br />

the Classification of Lupus Nephritis: The classification of<br />

glomerulonephritis in systemic lupus erythematosus revisited.<br />

Kidney Int. 2004; 65: 521-30.<br />

9. Wallace JD, Hahn BH, Klippel JH. Clinical and<br />

laboratory features of lupus nephritis. In: Dubois Lupus<br />

erythematosus. Wallace DJ, Hahn BH, editors. Philadelphia:<br />

Lippincott Williams & Wilkins. 2002. p. 1077-1091.<br />

10. Medeiros. Análise de 95 biópsias renais de pacientes<br />

com nefrite lúpica: correlação clínico-histológica e fatores<br />

associados à insuficiência renal crônica. Rev Bras Reumatol.<br />

2004; 4(44): 268-76.<br />

11. Appel GB, Cohen DJ, Pirani CL, et al: Long-term<br />

follow-up of patients with lupus nephritis. A study based on<br />

the classification of the World Health Organization. Am J Med.<br />

1987; 83: 877-85.<br />

12. Austin HA, Muenz LR, Joyce KM. Prognostic factors<br />

in lupus nephritis. Contribution of renal histologic data. Am J<br />

Med. 1983; 75: 382-91.<br />

13. Esdaile JM, Levinton C, Federgreen W, Hayslett J,<br />

Kashgarian M. The clinical and renal biopsy predictors of long<br />

term outcome in lupus nephritis: A study of 87 patients and<br />

review of the literature. Q J Méd. 1989; 72: 779-833.<br />

14. Austin HA, Klippel JH, Balow JE. Therapy of lupus<br />

nephritis – Controlled trial of prednisolone and cytotoxic<br />

drugs. N Engl J Med. 1986; 314: 614-9.<br />

15. Balbi AL. Estudo comparativo das complicações<br />

terapêuticas no Lúpus eritematoso sistêmico e nas<br />

glomerulopatias idiopáticas. Rev. Assoc. Med. Bras. São Paulo:<br />

47(4).<br />

16. Tan EM, Cohen AS, Fries JF, Masi AT, MaShane DJ,<br />

Rothfield NF et al. Special article: The 1982 revised criteria<br />

for the classification of sytemic lupus erythematosus. Arhritis<br />

Rheum. 1982; 25: 1271-1277.<br />

17. Fernandes JMC. Elementos básicos de diagnóstico<br />

do lúpus eritematoso sistêmico (LES). <strong>Revista</strong> Temas de<br />

Reumatologia. 2000; 1(3).<br />

18. Ravinal RC, Costa RS, Coimbra TM. Classes,<br />

activity and chronicity índices, and alpha-smooth muscle<br />

actin expression as prognostic parameters in lupus nephritis<br />

outcome. Lupus. 2002; 11: 82-7.<br />

19. Flanc RS, Roberts MA, Strippoli GM. Treatment<br />

of diffuse proliferative Lupus Nephritis: a meta-analysis of<br />

randomized controlled trials. Am J Kidney Dis. 2004; 43: 197-208.<br />

20. Boumpas D, Austin H, Vaughan E. Controlled trial<br />

of pulse methyprednisolone versus two regimens of pulse<br />

cyclophosphamidein severe lupus nephritis. Lancet. 1992; 5:<br />

340-741.<br />

21. Gourley M, Austin H, Scott D: Methylprednisolone<br />

and cyclophosphamide, alone or in combination, in patients<br />

with lupus nephritis: a randomized, controlled trial. Ann<br />

Intern Med. 1996; 125: 549-557.<br />

22. Araújo CS, Pestana M. Tratamento da Nefrite Lúpica.<br />

Acta Med Port. 2008; 21: 259-272.<br />

79<br />

revistahugv - <strong>Revista</strong> do <strong>Hospital</strong> Universitário Getúlio <strong>Vargas</strong><br />

v.9. n. 1-2 jan./dez. – <strong>2010</strong>

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