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Nephron Clin Pract. 2014;128(3-4):205-15. doi: 10.1159/000368569. Epub 2014 Nov 19.

Limitations of standard immunosuppressive treatment in ANCA-associated vasculitis and lupus nephritis.

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Department of Nephrology, 1st Faculty of Medicine, General University Hospital, Charles University, Prague, Czech Republic.


Introduction of the standard immunosuppressive treatment has dramatically changed the outcome of patients with both ANCA-associated vasculitis and lupus nephritis, transforming them from incurable diseases with very high short-term mortality to chronic debilitating diseases with much lower short-term, but still relatively high long-term, morbidity/mortality. Long-term morbidity with damage accumulating partly due to the adverse events of the available treatment (namely gonadal toxicity, malignancy, bone disease, cataracts, diabetes, and thromboembolic and cardiovascular disease) has become a major concern. Although cyclophosphamide-based regimens have been partly replaced by newer agents in both ANCA-associated vasculitis and lupus nephritis (namely rituximab or mycophenolate, respectively) their short-term and medium-term adverse events may not be significantly less frequent and we can only hope that new treatments will translate into better long-term outcomes including better long-term safety.

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