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07:29
Intravascular Delivery of Biologics to the Rat Kidney
Published on: September 1, 2016
Interventions for renal vasculitis in adults. A systematic review
Giles D Walters1, Narelle S Willis, Jonathan C Craig
1The Canberra Hospital, Canberra, Australia. giles.walters@act.gov.au
BMC Nephrology
|June 25, 2010
Summary
Plasma exchange effectively treats severe acute kidney injury from vasculitis. Continuous cyclophosphamide is preferred over pulse dosing to reduce relapse risk, with newer agents showing promise for maintenance therapy.
Area of Science:
- Nephrology
- Immunology
- Internal Medicine
Background:
- Renal vasculitis causes acute kidney failure, hematuria, and proteinuria.
- Current treatments include steroids, non-steroids, and plasma exchange.
- Uncertainties exist regarding optimal treatment duration, dosage, and new therapeutic roles.
Purpose of the Study:
- To systematically review the benefits and harms of interventions for adult renal vasculitis.
- To evaluate the efficacy of different immunosuppressive agents and plasma exchange.
Main Methods:
- Systematic review of randomized controlled trials up to June 2009.
- Searched Cochrane Central Register, Cochrane Renal Group Register, MEDLINE, and EMBASE.
- Data extracted and quality assessed by two independent authors; random effects model used for analysis.
Main Results:
- Twenty-two studies (1674 patients) included.
- Plasma exchange reduced end-stage kidney disease risk (RR 0.47).
- Continuous cyclophosphamide showed equivalent remission rates to pulse dosing but lower relapse risk (RR 1.79).
- Azathioprine, mycophenolate mofetil, rituximab, methotrexate, and leflunomide demonstrated efficacy in induction or maintenance therapy.
Conclusions:
- Plasma exchange is beneficial for severe acute kidney injury due to vasculitis.
- Continuous oral cyclophosphamide is preferred over pulse therapy to minimize relapse.
- Rituximab and mycophenolate mofetil are effective induction agents; azathioprine, methotrexate, and leflunomide are effective maintenance therapies.
- Further research is needed to define the role of newer agents in evidence-based treatment strategies.
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