array:21 [
  "pii" => "X2013251412001822"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.pre2012.Jun.11527"
  "estado" => "S300"
  "fechaPublicacion" => "2012-09-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia (English Version). 2012;32:679-80"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 3551
    "formatos" => array:3 [
      "EPUB" => 299
      "HTML" => 2745
      "PDF" => 507
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699512001825"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.pre2012.Jun.11527"
      "estado" => "S300"
      "fechaPublicacion" => "2012-09-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2012;32:679-80"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 6407
        "formatos" => array:3 [
          "EPUB" => 324
          "HTML" => 5492
          "PDF" => 591
        ]
      ]
      "es" => array:9 [
        "idiomaDefecto" => true
        "titulo" => "Tratamiento inmunosupresor de nefritis lúpica en insuficiencia renal grave. Sobre el estudio ALMS"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "679"
            "paginaFinal" => "680"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Immunosuppressive treatment of lupus nephritis in severe renal impairment. About the ALMS study"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Adoración Martín-Gómez"
            "autores" => array:1 [
              0 => array:2 [
                "nombre" => "Adoración"
                "apellidos" => "Martín-Gómez"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251412001822"
          "doi" => "10.3265/Nefrologia.pre2012.Jun.11527"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412001822?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512001825?idApp=UINPBA000064"
      "url" => "/02116995/0000003200000005/v0_201502091343/X0211699512001825/v0_201502091344/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X2013251412001814"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2012.Jun.11528"
    "estado" => "S300"
    "fechaPublicacion" => "2012-09-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2012;32:680-2"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3755
      "formatos" => array:3 [
        "EPUB" => 303
        "HTML" => 2947
        "PDF" => 505
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "titulo" => "On-Line haemodialfiltration versus high flux haemodialysis"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "680"
          "paginaFinal" => "682"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Hemodiafiltración on-line frente a hemodiálisis de alto flujo"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig1"
          "etiqueta" => "Tab.  1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier España"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "11528_16025_36080_en_t111528.jpg"
              "Alto" => 517
              "Ancho" => 1443
              "Tamanyo" => 284388
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Patient Data"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Antonio Gomis-Couto, Sandra Elías, Milagros Fernández-Lucas, Gloria Ruiz-Roso, Martha Díaz-Domínguez, José L. Teruel, Carlos Quereda"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "Antonio"
              "apellidos" => "Gomis-Couto"
            ]
            1 => array:2 [
              "nombre" => "Sandra"
              "apellidos" => "Elías"
            ]
            2 => array:2 [
              "nombre" => "Milagros"
              "apellidos" => "Fernández-Lucas"
            ]
            3 => array:2 [
              "nombre" => "Gloria"
              "apellidos" => "Ruiz-Roso"
            ]
            4 => array:2 [
              "nombre" => "Martha"
              "apellidos" => "Díaz-Domínguez"
            ]
            5 => array:2 [
              "nombre" => "José L."
              "apellidos" => "Teruel"
            ]
            6 => array:2 [
              "nombre" => "Carlos"
              "apellidos" => "Quereda"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699512001817"
        "doi" => "10.3265/Nefrologia.pre2012.Jun.11528"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512001817?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412001814?idApp=UINPBA000064"
    "url" => "/20132514/0000003200000005/v0_201502091606/X2013251412001814/v0_201502091606/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X2013251412001830"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2012.Jun.11541"
    "estado" => "S300"
    "fechaPublicacion" => "2012-09-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2012;32:679"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3534
      "formatos" => array:3 [
        "EPUB" => 289
        "HTML" => 2695
        "PDF" => 550
      ]
    ]
    "en" => array:8 [
      "idiomaDefecto" => true
      "titulo" => "Dialysis hypotension and vasopressin"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:1 [
          "paginaInicial" => "679"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Esmée M. Ettema, Casper F.M. Franssen"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "Esmée M."
              "apellidos" => "Ettema"
            ]
            1 => array:2 [
              "nombre" => "Casper F.M."
              "apellidos" => "Franssen"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "X0211699512001833"
        "doi" => "10.3265/Nefrologia.pre2012.Jun.11541"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512001833?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412001830?idApp=UINPBA000064"
    "url" => "/20132514/0000003200000005/v0_201502091606/X2013251412001830/v0_201502091606/en/main.assets"
  ]
  "en" => array:9 [
    "idiomaDefecto" => true
    "titulo" => "Immunosuppressive treatment of lupus nephritis in severe renal impairment. About the ALMS study"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "679"
        "paginaFinal" => "680"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Adoración Martín-Gómez"
        "autores" => array:1 [
          0 => array:4 [
            "nombre" => "Adoración"
            "apellidos" => "Martín-Gómez"
            "email" => array:1 [
              0 => "doritamg@gmail.com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:3 [
            "entidad" => "Servicio de Nefrología, Hospital de Poniente, El Ejido, Almería  "
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Tratamiento inmunosupresor de nefritis l&#250;pica en insuficiencia renal grave&#46; Sobre el estudio ALMS"
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor</span>&#58;</p><p class="elsevierStylePara">Regarding the Consensus Document published in this magazine last February on the diagnosis and treatment of lupus nephritis &#40;LN&#41;<span class="elsevierStyleSup">1</span>&#44; I want to congratulate the group for such exquisite work&#44; from which we hope to optimise treatment of patients with this pathology&#46; From reading this piece two thoughts emerged&#58;</p><p class="elsevierStylePara">1&#46; Houssiau<span class="elsevierStyleSup">2</span> refers&#44; in an editorial accompanying the ALMS<span class="elsevierStyleSup">3</span> study release&#44; that among patients who received maintenance therapy with mycophenolate &#40;MMF&#41;&#44; the ones who had previously received cyclophosphamide &#40;CYC&#41; induction obtained better results on the main variable outcome of the maintenance phase &#40;11 vs&#46; 21&#37; in death&#44; doubling of baseline creatinine&#44; advanced chronic kidney disease&#44; renal flare or salvage therapy&#41;&#44; but with no significant differences&#46; This is also a subgroup analysis&#44; which binds us to be cautious of interpretations&#46; Another subgroup analysis&#44; with the same cautious interpretation<span class="elsevierStyleSup">3</span>&#44; emphasizes that patients receiving CYC induction did significantly better with MMF compared to azathioprine &#40;AZT&#41; in maintenance &#40;4&#46;7 vs&#46; 14&#46;5 in relative risk of treatment failure&#41;&#46; Along the same lines&#44; though without achieving statistical significance&#44; subjects who received MMF induction also presented better results with MMF than with AZT &#40;relative risk 10&#46;1 vs&#46; 20&#46;1 on treatment failure&#41;&#46; On the American Nephrology Congress &#40;November 2011&#44; Philadelphia&#44; USA&#41; Appel GB mentioned&#44; regarding the ALMS study&#44; that &#34;patients who were treated with CYC induction presented less treatment failure on the maintenance phase than patients treated with MMF&#44; independently from the drug received on this second phase&#34;&#46; I believe this is the part you mentioned on the Consensus Document&#46; This statement would make us conclude that CYC induction adds an additional benefit regardless the immunosuppressive maintenance option&#46; This a theme to be debated&#44; although it can be subject to future research&#44; and we should examine it with discretion given that it originated from a subgroup analysis&#46;</p><p class="elsevierStylePara">2&#46; There are few studies on the best immunosuppression in patients with LN and renal clearance &#40;ClCr&#41; &#60;30ml&#47;min&#44; probably because reference studies with CYC excluded patients that presented stage 4 renal failure &#40;RF&#41;&#44; except for some involving a patient with creatinine of 4&#46;8mg&#47;dl<span class="elsevierStyleSup">4</span> with not many details and no results subanalysis&#46; Even so&#44; we have relied on the suitability of CYC in patients with severe LN and RF&#44; and thus have been captured in the Consensus Document&#46;</p><p class="elsevierStylePara">The ALMS study<span class="elsevierStyleSup">5</span> rated with a 4-5 score on the Jadad scale&#44; included a total of 32 patients &#40;8&#46;7&#37;&#41; with ClCr &#60;30ml&#47;min&#44; 20 &#40;10&#46;8&#37;&#41; in the MMF branch and 12 &#40;6&#46;5&#37;&#41; on CYC&#46; In the total group of 370 patients&#44; 122 had scarring on renal biopsy&#44; 66 &#40;35&#46;7&#37;&#41; on the MMF branch and 56 &#40;30&#37;&#41; on the CYC branch&#46; Regardless the data&#44; no differences were found between both groups in the main variable results&#44; which measured the efficacy of immunosuppressive treatment in inducing response&#46; Based on this data&#44; every day more of us begin induction treatment for LN class III-IV-V still with stage 4 RF with MMF and especially if the patients are women in their childbearing years&#46; Besides&#44; this kind of patients are treated with steroid pulses&#44; which will act more rapidly and effectively in reducing the acute inflammation in the renal parenchyma&#44; awaiting the additional benefit and hoping that they would add the non-steroid immunosuppressants&#46;</p><p class="elsevierStylePara">If we continue to recommend CYC in patients with creatinine &#62;3mg&#47;dl &#40;or with crescents&#47;fibrinoid necrosis on biopsy&#41;&#44; I believe that we will be depriving them from the opportunity of treatment with a drug free of gonadal toxicity and preventing the possibility of obtaining evidence with MMF on cases of important reduction of glomerular filtration rate&#44; as long as it is a individualized responsible decision&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors have no conflict of interests to declare&#46;</p>"
    "pdfFichero" => "P1-E543-S3701-A11527-EN.pdf"
    "tienePdf" => true
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000003200000005/v0_201502091606/X2013251412001822/v0_201502091606/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "35439"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Letters to the Editor - Comments on published articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003200000005/v0_201502091606/X2013251412001822/v0_201502091606/en/P1-E543-S3701-A11527-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412001822?idApp=UINPBA000064"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Immunosuppressive treatment of lupus nephritis in severe renal impairment. About the ALMS study
Tratamiento inmunosupresor de nefritis lúpica en insuficiencia renal grave. Sobre el estudio ALMS
Adoración Martín-Gómeza
a Servicio de Nefrología, Hospital de Poniente, El Ejido, Almería
Read
7012
Times
was read the article
2079
Total PDF
4933
Total HTML
Share statistics
 array:21 [
  "pii" => "X2013251412001822"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.pre2012.Jun.11527"
  "estado" => "S300"
  "fechaPublicacion" => "2012-09-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia &#40;English Version&#41;. 2012;32:679-80"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 3551
    "formatos" => array:3 [
      "EPUB" => 299
      "HTML" => 2745
      "PDF" => 507
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699512001825"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.pre2012.Jun.11527"
      "estado" => "S300"
      "fechaPublicacion" => "2012-09-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2012;32:679-80"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 6407
        "formatos" => array:3 [
          "EPUB" => 324
          "HTML" => 5492
          "PDF" => 591
        ]
      ]
      "es" => array:9 [
        "idiomaDefecto" => true
        "titulo" => "Tratamiento inmunosupresor de nefritis l&#250;pica en insuficiencia renal grave&#46; Sobre el estudio ALMS"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "679"
            "paginaFinal" => "680"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Immunosuppressive treatment of lupus nephritis in severe renal impairment&#46; About the ALMS study"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Adoraci&#243;n Mart&#237;n-G&#243;mez"
            "autores" => array:1 [
              0 => array:2 [
                "nombre" => "Adoraci&#243;n"
                "apellidos" => "Mart&#237;n-G&#243;mez"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251412001822"
          "doi" => "10.3265/Nefrologia.pre2012.Jun.11527"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412001822?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512001825?idApp=UINPBA000064"
      "url" => "/02116995/0000003200000005/v0_201502091343/X0211699512001825/v0_201502091344/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X2013251412001814"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2012.Jun.11528"
    "estado" => "S300"
    "fechaPublicacion" => "2012-09-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia &#40;English Version&#41;. 2012;32:680-2"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3755
      "formatos" => array:3 [
        "EPUB" => 303
        "HTML" => 2947
        "PDF" => 505
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "titulo" => "On-Line haemodialfiltration versus high flux haemodialysis"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "680"
          "paginaFinal" => "682"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Hemodiafiltraci&#243;n on-line frente a hemodi&#225;lisis de alto flujo"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig1"
          "etiqueta" => "Tab.  1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier Espa&#241;a"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "11528_16025_36080_en_t111528.jpg"
              "Alto" => 517
              "Ancho" => 1443
              "Tamanyo" => 284388
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Patient Data"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Antonio Gomis-Couto, Sandra El&#237;as, Milagros Fern&#225;ndez-Lucas, Gloria Ruiz-Roso, Martha D&#237;az-Dom&#237;nguez, Jos&#233; L&#46; Teruel, Carlos Quereda"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "Antonio"
              "apellidos" => "Gomis-Couto"
            ]
            1 => array:2 [
              "nombre" => "Sandra"
              "apellidos" => "El&#237;as"
            ]
            2 => array:2 [
              "nombre" => "Milagros"
              "apellidos" => "Fern&#225;ndez-Lucas"
            ]
            3 => array:2 [
              "nombre" => "Gloria"
              "apellidos" => "Ruiz-Roso"
            ]
            4 => array:2 [
              "nombre" => "Martha"
              "apellidos" => "D&#237;az-Dom&#237;nguez"
            ]
            5 => array:2 [
              "nombre" => "Jos&#233; L&#46;"
              "apellidos" => "Teruel"
            ]
            6 => array:2 [
              "nombre" => "Carlos"
              "apellidos" => "Quereda"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699512001817"
        "doi" => "10.3265/Nefrologia.pre2012.Jun.11528"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512001817?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412001814?idApp=UINPBA000064"
    "url" => "/20132514/0000003200000005/v0_201502091606/X2013251412001814/v0_201502091606/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X2013251412001830"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2012.Jun.11541"
    "estado" => "S300"
    "fechaPublicacion" => "2012-09-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia &#40;English Version&#41;. 2012;32:679"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3534
      "formatos" => array:3 [
        "EPUB" => 289
        "HTML" => 2695
        "PDF" => 550
      ]
    ]
    "en" => array:8 [
      "idiomaDefecto" => true
      "titulo" => "Dialysis hypotension and vasopressin"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:1 [
          "paginaInicial" => "679"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Esm&#233;e M&#46; Ettema, Casper F&#46;M&#46; Franssen"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "Esm&#233;e M&#46;"
              "apellidos" => "Ettema"
            ]
            1 => array:2 [
              "nombre" => "Casper F&#46;M&#46;"
              "apellidos" => "Franssen"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "X0211699512001833"
        "doi" => "10.3265/Nefrologia.pre2012.Jun.11541"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512001833?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412001830?idApp=UINPBA000064"
    "url" => "/20132514/0000003200000005/v0_201502091606/X2013251412001830/v0_201502091606/en/main.assets"
  ]
  "en" => array:9 [
    "idiomaDefecto" => true
    "titulo" => "Immunosuppressive treatment of lupus nephritis in severe renal impairment&#46; About the ALMS study"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "679"
        "paginaFinal" => "680"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Adoraci&#243;n Mart&#237;n-G&#243;mez"
        "autores" => array:1 [
          0 => array:4 [
            "nombre" => "Adoraci&#243;n"
            "apellidos" => "Mart&#237;n-G&#243;mez"
            "email" => array:1 [
              0 => "doritamg&#64;gmail&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:3 [
            "entidad" => "Servicio de Nefrología, Hospital de Poniente, El Ejido, Almería  "
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Tratamiento inmunosupresor de nefritis l&#250;pica en insuficiencia renal grave&#46; Sobre el estudio ALMS"
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor</span>&#58;</p><p class="elsevierStylePara">Regarding the Consensus Document published in this magazine last February on the diagnosis and treatment of lupus nephritis &#40;LN&#41;<span class="elsevierStyleSup">1</span>&#44; I want to congratulate the group for such exquisite work&#44; from which we hope to optimise treatment of patients with this pathology&#46; From reading this piece two thoughts emerged&#58;</p><p class="elsevierStylePara">1&#46; Houssiau<span class="elsevierStyleSup">2</span> refers&#44; in an editorial accompanying the ALMS<span class="elsevierStyleSup">3</span> study release&#44; that among patients who received maintenance therapy with mycophenolate &#40;MMF&#41;&#44; the ones who had previously received cyclophosphamide &#40;CYC&#41; induction obtained better results on the main variable outcome of the maintenance phase &#40;11 vs&#46; 21&#37; in death&#44; doubling of baseline creatinine&#44; advanced chronic kidney disease&#44; renal flare or salvage therapy&#41;&#44; but with no significant differences&#46; This is also a subgroup analysis&#44; which binds us to be cautious of interpretations&#46; Another subgroup analysis&#44; with the same cautious interpretation<span class="elsevierStyleSup">3</span>&#44; emphasizes that patients receiving CYC induction did significantly better with MMF compared to azathioprine &#40;AZT&#41; in maintenance &#40;4&#46;7 vs&#46; 14&#46;5 in relative risk of treatment failure&#41;&#46; Along the same lines&#44; though without achieving statistical significance&#44; subjects who received MMF induction also presented better results with MMF than with AZT &#40;relative risk 10&#46;1 vs&#46; 20&#46;1 on treatment failure&#41;&#46; On the American Nephrology Congress &#40;November 2011&#44; Philadelphia&#44; USA&#41; Appel GB mentioned&#44; regarding the ALMS study&#44; that &#34;patients who were treated with CYC induction presented less treatment failure on the maintenance phase than patients treated with MMF&#44; independently from the drug received on this second phase&#34;&#46; I believe this is the part you mentioned on the Consensus Document&#46; This statement would make us conclude that CYC induction adds an additional benefit regardless the immunosuppressive maintenance option&#46; This a theme to be debated&#44; although it can be subject to future research&#44; and we should examine it with discretion given that it originated from a subgroup analysis&#46;</p><p class="elsevierStylePara">2&#46; There are few studies on the best immunosuppression in patients with LN and renal clearance &#40;ClCr&#41; &#60;30ml&#47;min&#44; probably because reference studies with CYC excluded patients that presented stage 4 renal failure &#40;RF&#41;&#44; except for some involving a patient with creatinine of 4&#46;8mg&#47;dl<span class="elsevierStyleSup">4</span> with not many details and no results subanalysis&#46; Even so&#44; we have relied on the suitability of CYC in patients with severe LN and RF&#44; and thus have been captured in the Consensus Document&#46;</p><p class="elsevierStylePara">The ALMS study<span class="elsevierStyleSup">5</span> rated with a 4-5 score on the Jadad scale&#44; included a total of 32 patients &#40;8&#46;7&#37;&#41; with ClCr &#60;30ml&#47;min&#44; 20 &#40;10&#46;8&#37;&#41; in the MMF branch and 12 &#40;6&#46;5&#37;&#41; on CYC&#46; In the total group of 370 patients&#44; 122 had scarring on renal biopsy&#44; 66 &#40;35&#46;7&#37;&#41; on the MMF branch and 56 &#40;30&#37;&#41; on the CYC branch&#46; Regardless the data&#44; no differences were found between both groups in the main variable results&#44; which measured the efficacy of immunosuppressive treatment in inducing response&#46; Based on this data&#44; every day more of us begin induction treatment for LN class III-IV-V still with stage 4 RF with MMF and especially if the patients are women in their childbearing years&#46; Besides&#44; this kind of patients are treated with steroid pulses&#44; which will act more rapidly and effectively in reducing the acute inflammation in the renal parenchyma&#44; awaiting the additional benefit and hoping that they would add the non-steroid immunosuppressants&#46;</p><p class="elsevierStylePara">If we continue to recommend CYC in patients with creatinine &#62;3mg&#47;dl &#40;or with crescents&#47;fibrinoid necrosis on biopsy&#41;&#44; I believe that we will be depriving them from the opportunity of treatment with a drug free of gonadal toxicity and preventing the possibility of obtaining evidence with MMF on cases of important reduction of glomerular filtration rate&#44; as long as it is a individualized responsible decision&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors have no conflict of interests to declare&#46;</p>"
    "pdfFichero" => "P1-E543-S3701-A11527-EN.pdf"
    "tienePdf" => true
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000003200000005/v0_201502091606/X2013251412001822/v0_201502091606/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "35439"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Letters to the Editor - Comments on published articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003200000005/v0_201502091606/X2013251412001822/v0_201502091606/en/P1-E543-S3701-A11527-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412001822?idApp=UINPBA000064"
]
Article information
ISSN: 20132514
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 7 6 13
2024 October 37 34 71
2024 September 52 23 75
2024 August 58 49 107
2024 July 44 34 78
2024 June 62 39 101
2024 May 60 27 87
2024 April 42 38 80
2024 March 40 26 66
2024 February 33 34 67
2024 January 34 30 64
2023 December 19 23 42
2023 November 37 41 78
2023 October 44 32 76
2023 September 60 30 90
2023 August 62 23 85
2023 July 51 26 77
2023 June 80 32 112
2023 May 52 33 85
2023 April 62 20 82
2023 March 67 14 81
2023 February 47 29 76
2023 January 37 27 64
2022 December 43 24 67
2022 November 42 38 80
2022 October 33 28 61
2022 September 40 27 67
2022 August 45 33 78
2022 July 32 43 75
2022 June 38 34 72
2022 May 21 31 52
2022 April 42 42 84
2022 March 38 49 87
2022 February 29 38 67
2022 January 26 25 51
2021 December 34 37 71
2021 November 27 37 64
2021 October 30 31 61
2021 September 29 34 63
2021 August 28 37 65
2021 July 26 23 49
2021 June 23 15 38
2021 May 29 31 60
2021 April 60 38 98
2021 March 40 56 96
2021 February 36 20 56
2021 January 30 16 46
2020 December 16 16 32
2020 November 35 10 45
2020 October 21 16 37
2020 September 12 6 18
2020 August 40 8 48
2020 July 27 11 38
2020 June 31 11 42
2020 May 24 12 36
2020 April 32 13 45
2020 March 32 7 39
2020 February 20 16 36
2020 January 32 17 49
2019 December 39 16 55
2019 November 27 22 49
2019 October 13 6 19
2019 September 18 20 38
2019 August 13 10 23
2019 July 18 24 42
2019 June 23 12 35
2019 May 21 14 35
2019 April 52 23 75
2019 March 20 16 36
2019 February 13 14 27
2019 January 34 20 54
2018 December 64 31 95
2018 November 67 13 80
2018 October 45 16 61
2018 September 55 15 70
2018 August 39 11 50
2018 July 41 12 53
2018 June 44 16 60
2018 May 44 11 55
2018 April 60 9 69
2018 March 39 17 56
2018 February 34 8 42
2018 January 37 7 44
2017 December 44 9 53
2017 November 33 7 40
2017 October 29 5 34
2017 September 37 10 47
2017 August 27 6 33
2017 July 31 9 40
2017 June 23 5 28
2017 May 31 7 38
2017 April 42 7 49
2017 March 35 1 36
2017 February 22 6 28
2017 January 20 4 24
2016 December 30 4 34
2016 November 40 11 51
2016 October 67 9 76
2016 September 54 3 57
2016 August 115 3 118
2016 July 107 10 117
2016 June 114 0 114
2016 May 88 0 88
2016 April 87 0 87
2016 March 55 0 55
2016 February 88 0 88
2016 January 68 0 68
2015 December 112 0 112
2015 November 72 0 72
2015 October 88 0 88
2015 September 66 0 66
2015 August 48 0 48
2015 July 70 0 70
2015 June 40 0 40
2015 May 55 0 55
2015 April 5 0 5
Show all

Follow this link to access the full text of the article

Idiomas
Nefrología (English Edition)
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?