Prednisone Improves Renal Function and Proteinuria in Human Immunodeficiency Virus-associated Nephropathy
To determine if prednisone ameliorates the course of human immunodeficiency virus-associated nephropathy (HIV-AN). Patients and Methods: Twenty consecutive HIV-infected adults with biopsy-proven HIV-AN (n = 17) or clinical characteristics of HIV-AN (n = 3) with serum creatinine concentrations >17...
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| Veröffentlicht in: | The American journal of medicine 1996-07, Vol.101 (1), p.41-48 |
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| creator | Smith, Michael C. Austen, Jeffrey L. Carey, John T. Emancipator, Steven N. Herbener, Thomas Gripshover, Barbara Mbanefo, Charles Phinney, Melinda Rahman, Mahboob Salata, Robert A. Weigel, Kelly Kalayjian, Robert C. |
| description | To determine if prednisone ameliorates the course of human immunodeficiency virus-associated nephropathy (HIV-AN). Patients and Methods: Twenty consecutive HIV-infected adults with biopsy-proven HIV-AN (n = 17) or clinical characteristics of HIV-AN (n = 3) with serum creatinine concentrations >177 μmol/L (2 mg/dL) or proteinuria >2.0 g/d or both were prospectively evaluated and treated with prednisone at a dose of 60 mg/d for 2 to 11 weeks, followed by a tapering course of prednisone over a 2- to 26-week period. Serum creatinine concentration, 24-hour protein excretion, serum albumin, and steroidrelated adverse effects were assessed before and after treatment.
Nineteen patients had serum creatinine concentrations >177 μmol/L (2 mg/ dL). Two of them progressed to end stage renal disease (ESRD) in 4 to 5 weeks. In 17 patients serum creatinine levels decreased from 717 ±103 μmol/L (8.1 ± 1.2 mg/dL) (mean ± SE) to 262 ± 31 μmol/L (3.0 ± 0.4 mg/dL) (
P |
| doi_str_mv | 10.1016/S0002-9343(96)00065-4 |
| format | Article |
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Nineteen patients had serum creatinine concentrations >177 μmol/L (2 mg/ dL). Two of them progressed to end stage renal disease (ESRD) in 4 to 5 weeks. In 17 patients serum creatinine levels decreased from 717 ±103 μmol/L (8.1 ± 1.2 mg/dL) (mean ± SE) to 262 ± 31 μmol/L (3.0 ± 0.4 mg/dL) (
P <0.001). Five patients relapsed after prednisone was discontinued and were retreated. In these 5 the serum creatinine declined from 728 ± 107 μmol/L (8.2 ± 1.2 mg/dL) to 344 ± 47 μmol/L (3.9 ± 0.5 mg/ dL) (
P <0.01) in response to the second course of prednisone.
Twelve of 13 tested patients showed a reduction in 24-hour urinary protein excretion with an average decrement from 9.1 ± 1.8 g/d to 3.2 ± 0.6 g/d (
P <0.005). Serum albumin increased from 24.4 ± 3.6 g/L to 29.3 ± 2.6 g/L (
P =NS) in the 11 patients with paired 24-hour urine collections for whom pre- and posttreatment determinations were available. In one non-azotemic patient with nephrotic syndrome, protein excretion declined from 15.2 to 2.2 g/ day and the serum albumin increased from 4.0 g/L to 31.0 g/L.
The 20 patients have been followed for a median of 44 weeks (range 8 to 107). Eight ultimately required maintenance dialysis. Eleven died from complications of HIV disease 14 to 107 weeks after institution of prednisone; none was receiving prednisone at the time of death. Seven are alive and free from ESRD a median of 25 weeks (range 8 to 81) from the initiation of prednisone therapy. Six patients developed a total of seven serious infections while receiving prednisone, including
Mycobacterium aviumcomplex infection in 2 and CMV retinitis in 3.
Prednisone improves serum creatinine and proteinuria in a substantial proportion of adults with HIV-AN. Corticosteroidrelated side effects are not prohibitive. A prospective, randomized controlled trial is required to confirm these preliminary results.</description><identifier>ISSN: 0002-9343</identifier><identifier>EISSN: 1555-7162</identifier><identifier>DOI: 10.1016/S0002-9343(96)00065-4</identifier><identifier>PMID: 8686713</identifier><identifier>CODEN: AJMEAZ</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adult ; Aged ; AIDS/HIV ; Biological and medical sciences ; Creatinine - blood ; Disease ; Drug therapy ; Female ; Follow-Up Studies ; Glucocorticoids - therapeutic use ; HIV ; HIV Infections - blood ; HIV Infections - complications ; Human immunodeficiency virus ; Humans ; Immunodeficiencies ; Immunodeficiencies. Immunoglobulinopathies ; Immunopathology ; Kidney Diseases - blood ; Kidney Diseases - complications ; Kidney Diseases - drug therapy ; Kidney Diseases - virology ; Kidney Failure, Chronic - drug therapy ; Kidneys ; Male ; Medical research ; Medical sciences ; Middle Aged ; Prednisone - therapeutic use ; Prospective Studies ; Proteinuria - blood ; Proteinuria - etiology ; Proteinuria - prevention & control ; Recurrence</subject><ispartof>The American journal of medicine, 1996-07, Vol.101 (1), p.41-48</ispartof><rights>1996 Excerpta Medica, Inc. All rights reserved.</rights><rights>1996 INIST-CNRS</rights><rights>Copyright Elsevier Sequoia S.A. Jul 1996</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c468t-f4d3ea398f8bb55c58c628d5732a522021216b90eb83f9ff8e92c846993603ff3</citedby><cites>FETCH-LOGICAL-c468t-f4d3ea398f8bb55c58c628d5732a522021216b90eb83f9ff8e92c846993603ff3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/S0002-9343(96)00065-4$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=3166336$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/8686713$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Smith, Michael C.</creatorcontrib><creatorcontrib>Austen, Jeffrey L.</creatorcontrib><creatorcontrib>Carey, John T.</creatorcontrib><creatorcontrib>Emancipator, Steven N.</creatorcontrib><creatorcontrib>Herbener, Thomas</creatorcontrib><creatorcontrib>Gripshover, Barbara</creatorcontrib><creatorcontrib>Mbanefo, Charles</creatorcontrib><creatorcontrib>Phinney, Melinda</creatorcontrib><creatorcontrib>Rahman, Mahboob</creatorcontrib><creatorcontrib>Salata, Robert A.</creatorcontrib><creatorcontrib>Weigel, Kelly</creatorcontrib><creatorcontrib>Kalayjian, Robert C.</creatorcontrib><title>Prednisone Improves Renal Function and Proteinuria in Human Immunodeficiency Virus-associated Nephropathy</title><title>The American journal of medicine</title><addtitle>Am J Med</addtitle><description>To determine if prednisone ameliorates the course of human immunodeficiency virus-associated nephropathy (HIV-AN). Patients and Methods: Twenty consecutive HIV-infected adults with biopsy-proven HIV-AN (n = 17) or clinical characteristics of HIV-AN (n = 3) with serum creatinine concentrations >177 μmol/L (2 mg/dL) or proteinuria >2.0 g/d or both were prospectively evaluated and treated with prednisone at a dose of 60 mg/d for 2 to 11 weeks, followed by a tapering course of prednisone over a 2- to 26-week period. Serum creatinine concentration, 24-hour protein excretion, serum albumin, and steroidrelated adverse effects were assessed before and after treatment.
Nineteen patients had serum creatinine concentrations >177 μmol/L (2 mg/ dL). Two of them progressed to end stage renal disease (ESRD) in 4 to 5 weeks. In 17 patients serum creatinine levels decreased from 717 ±103 μmol/L (8.1 ± 1.2 mg/dL) (mean ± SE) to 262 ± 31 μmol/L (3.0 ± 0.4 mg/dL) (
P <0.001). Five patients relapsed after prednisone was discontinued and were retreated. In these 5 the serum creatinine declined from 728 ± 107 μmol/L (8.2 ± 1.2 mg/dL) to 344 ± 47 μmol/L (3.9 ± 0.5 mg/ dL) (
P <0.01) in response to the second course of prednisone.
Twelve of 13 tested patients showed a reduction in 24-hour urinary protein excretion with an average decrement from 9.1 ± 1.8 g/d to 3.2 ± 0.6 g/d (
P <0.005). Serum albumin increased from 24.4 ± 3.6 g/L to 29.3 ± 2.6 g/L (
P =NS) in the 11 patients with paired 24-hour urine collections for whom pre- and posttreatment determinations were available. In one non-azotemic patient with nephrotic syndrome, protein excretion declined from 15.2 to 2.2 g/ day and the serum albumin increased from 4.0 g/L to 31.0 g/L.
The 20 patients have been followed for a median of 44 weeks (range 8 to 107). Eight ultimately required maintenance dialysis. Eleven died from complications of HIV disease 14 to 107 weeks after institution of prednisone; none was receiving prednisone at the time of death. Seven are alive and free from ESRD a median of 25 weeks (range 8 to 81) from the initiation of prednisone therapy. Six patients developed a total of seven serious infections while receiving prednisone, including
Mycobacterium aviumcomplex infection in 2 and CMV retinitis in 3.
Prednisone improves serum creatinine and proteinuria in a substantial proportion of adults with HIV-AN. Corticosteroidrelated side effects are not prohibitive. A prospective, randomized controlled trial is required to confirm these preliminary results.</description><subject>Adult</subject><subject>Aged</subject><subject>AIDS/HIV</subject><subject>Biological and medical sciences</subject><subject>Creatinine - blood</subject><subject>Disease</subject><subject>Drug therapy</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Glucocorticoids - therapeutic use</subject><subject>HIV</subject><subject>HIV Infections - blood</subject><subject>HIV Infections - complications</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Immunodeficiencies</subject><subject>Immunodeficiencies. Immunoglobulinopathies</subject><subject>Immunopathology</subject><subject>Kidney Diseases - blood</subject><subject>Kidney Diseases - complications</subject><subject>Kidney Diseases - drug therapy</subject><subject>Kidney Diseases - virology</subject><subject>Kidney Failure, Chronic - drug therapy</subject><subject>Kidneys</subject><subject>Male</subject><subject>Medical research</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Prednisone - therapeutic use</subject><subject>Prospective Studies</subject><subject>Proteinuria - blood</subject><subject>Proteinuria - etiology</subject><subject>Proteinuria - prevention & control</subject><subject>Recurrence</subject><issn>0002-9343</issn><issn>1555-7162</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1996</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU1r3DAQhkVpSLdpf0LAlFLag1N9WLJ0KiU0TSCkoV9XIUsjomBLG8kO7L-PsrvsoZeehmGed5h5X4ROCT4jmIjPvzDGtFWsYx-V-FQbwdvuBVoRznnbE0FfotUBeYVel3JfW6y4OEbHUkjRE7ZC4TaDi6GkCM3VtM7pEUrzE6IZm4sl2jmk2JjomtucZghxycE0ITaXy2RiFUxLTA58sAGi3TR_Q15Ka0pJNpgZXHMD67uc1ma-27xBR96MBd7u6wn6c_Ht9_lle_3j-9X51-vWdkLOre8cA8OU9HIYOLdcWkGl4z2jhlOKKaFEDArDIJlX3ktQ1MpOKMUEZt6zE_Rht7c-87BAmfUUioVxNBHSUnQvieQ97iv47h_wPi25fl40ZZR1UjFVIb6DbE6lZPB6ncNk8kYTrJ9z0Nsc9LPJWgm9zUF3VXe6X74ME7iDam98nb_fz02xZvTZRBvKAWNECMZExb7sMKiOPQbIumytBhcy2Fm7FP5zyBPPj6Si</recordid><startdate>19960701</startdate><enddate>19960701</enddate><creator>Smith, Michael C.</creator><creator>Austen, Jeffrey L.</creator><creator>Carey, John T.</creator><creator>Emancipator, Steven N.</creator><creator>Herbener, Thomas</creator><creator>Gripshover, Barbara</creator><creator>Mbanefo, Charles</creator><creator>Phinney, Melinda</creator><creator>Rahman, Mahboob</creator><creator>Salata, Robert A.</creator><creator>Weigel, Kelly</creator><creator>Kalayjian, Robert C.</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Sequoia S.A</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>7TO</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>19960701</creationdate><title>Prednisone Improves Renal Function and Proteinuria in Human Immunodeficiency Virus-associated Nephropathy</title><author>Smith, Michael C. ; Austen, Jeffrey L. ; Carey, John T. ; Emancipator, Steven N. ; Herbener, Thomas ; Gripshover, Barbara ; Mbanefo, Charles ; Phinney, Melinda ; Rahman, Mahboob ; Salata, Robert A. ; Weigel, Kelly ; Kalayjian, Robert C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c468t-f4d3ea398f8bb55c58c628d5732a522021216b90eb83f9ff8e92c846993603ff3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1996</creationdate><topic>Adult</topic><topic>Aged</topic><topic>AIDS/HIV</topic><topic>Biological and medical sciences</topic><topic>Creatinine - blood</topic><topic>Disease</topic><topic>Drug therapy</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Glucocorticoids - therapeutic use</topic><topic>HIV</topic><topic>HIV Infections - blood</topic><topic>HIV Infections - complications</topic><topic>Human immunodeficiency virus</topic><topic>Humans</topic><topic>Immunodeficiencies</topic><topic>Immunodeficiencies. Immunoglobulinopathies</topic><topic>Immunopathology</topic><topic>Kidney Diseases - blood</topic><topic>Kidney Diseases - complications</topic><topic>Kidney Diseases - drug therapy</topic><topic>Kidney Diseases - virology</topic><topic>Kidney Failure, Chronic - drug therapy</topic><topic>Kidneys</topic><topic>Male</topic><topic>Medical research</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Prednisone - therapeutic use</topic><topic>Prospective Studies</topic><topic>Proteinuria - blood</topic><topic>Proteinuria - etiology</topic><topic>Proteinuria - prevention & control</topic><topic>Recurrence</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Smith, Michael C.</creatorcontrib><creatorcontrib>Austen, Jeffrey L.</creatorcontrib><creatorcontrib>Carey, John T.</creatorcontrib><creatorcontrib>Emancipator, Steven N.</creatorcontrib><creatorcontrib>Herbener, Thomas</creatorcontrib><creatorcontrib>Gripshover, Barbara</creatorcontrib><creatorcontrib>Mbanefo, Charles</creatorcontrib><creatorcontrib>Phinney, Melinda</creatorcontrib><creatorcontrib>Rahman, Mahboob</creatorcontrib><creatorcontrib>Salata, Robert A.</creatorcontrib><creatorcontrib>Weigel, Kelly</creatorcontrib><creatorcontrib>Kalayjian, Robert C.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Physical Education Index</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Smith, Michael C.</au><au>Austen, Jeffrey L.</au><au>Carey, John T.</au><au>Emancipator, Steven N.</au><au>Herbener, Thomas</au><au>Gripshover, Barbara</au><au>Mbanefo, Charles</au><au>Phinney, Melinda</au><au>Rahman, Mahboob</au><au>Salata, Robert A.</au><au>Weigel, Kelly</au><au>Kalayjian, Robert C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prednisone Improves Renal Function and Proteinuria in Human Immunodeficiency Virus-associated Nephropathy</atitle><jtitle>The American journal of medicine</jtitle><addtitle>Am J Med</addtitle><date>1996-07-01</date><risdate>1996</risdate><volume>101</volume><issue>1</issue><spage>41</spage><epage>48</epage><pages>41-48</pages><issn>0002-9343</issn><eissn>1555-7162</eissn><coden>AJMEAZ</coden><abstract>To determine if prednisone ameliorates the course of human immunodeficiency virus-associated nephropathy (HIV-AN). Patients and Methods: Twenty consecutive HIV-infected adults with biopsy-proven HIV-AN (n = 17) or clinical characteristics of HIV-AN (n = 3) with serum creatinine concentrations >177 μmol/L (2 mg/dL) or proteinuria >2.0 g/d or both were prospectively evaluated and treated with prednisone at a dose of 60 mg/d for 2 to 11 weeks, followed by a tapering course of prednisone over a 2- to 26-week period. Serum creatinine concentration, 24-hour protein excretion, serum albumin, and steroidrelated adverse effects were assessed before and after treatment.
Nineteen patients had serum creatinine concentrations >177 μmol/L (2 mg/ dL). Two of them progressed to end stage renal disease (ESRD) in 4 to 5 weeks. In 17 patients serum creatinine levels decreased from 717 ±103 μmol/L (8.1 ± 1.2 mg/dL) (mean ± SE) to 262 ± 31 μmol/L (3.0 ± 0.4 mg/dL) (
P <0.001). Five patients relapsed after prednisone was discontinued and were retreated. In these 5 the serum creatinine declined from 728 ± 107 μmol/L (8.2 ± 1.2 mg/dL) to 344 ± 47 μmol/L (3.9 ± 0.5 mg/ dL) (
P <0.01) in response to the second course of prednisone.
Twelve of 13 tested patients showed a reduction in 24-hour urinary protein excretion with an average decrement from 9.1 ± 1.8 g/d to 3.2 ± 0.6 g/d (
P <0.005). Serum albumin increased from 24.4 ± 3.6 g/L to 29.3 ± 2.6 g/L (
P =NS) in the 11 patients with paired 24-hour urine collections for whom pre- and posttreatment determinations were available. In one non-azotemic patient with nephrotic syndrome, protein excretion declined from 15.2 to 2.2 g/ day and the serum albumin increased from 4.0 g/L to 31.0 g/L.
The 20 patients have been followed for a median of 44 weeks (range 8 to 107). Eight ultimately required maintenance dialysis. Eleven died from complications of HIV disease 14 to 107 weeks after institution of prednisone; none was receiving prednisone at the time of death. Seven are alive and free from ESRD a median of 25 weeks (range 8 to 81) from the initiation of prednisone therapy. Six patients developed a total of seven serious infections while receiving prednisone, including
Mycobacterium aviumcomplex infection in 2 and CMV retinitis in 3.
Prednisone improves serum creatinine and proteinuria in a substantial proportion of adults with HIV-AN. Corticosteroidrelated side effects are not prohibitive. A prospective, randomized controlled trial is required to confirm these preliminary results.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>8686713</pmid><doi>10.1016/S0002-9343(96)00065-4</doi><tpages>8</tpages></addata></record> |
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| ispartof | The American journal of medicine, 1996-07, Vol.101 (1), p.41-48 |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Adult Aged AIDS/HIV Biological and medical sciences Creatinine - blood Disease Drug therapy Female Follow-Up Studies Glucocorticoids - therapeutic use HIV HIV Infections - blood HIV Infections - complications Human immunodeficiency virus Humans Immunodeficiencies Immunodeficiencies. Immunoglobulinopathies Immunopathology Kidney Diseases - blood Kidney Diseases - complications Kidney Diseases - drug therapy Kidney Diseases - virology Kidney Failure, Chronic - drug therapy Kidneys Male Medical research Medical sciences Middle Aged Prednisone - therapeutic use Prospective Studies Proteinuria - blood Proteinuria - etiology Proteinuria - prevention & control Recurrence |
| title | Prednisone Improves Renal Function and Proteinuria in Human Immunodeficiency Virus-associated Nephropathy |
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