Timely referral to kidney transplant may improve survival for patients with lupus nephritis

January 21, 2019

1. Timely referral to kidney transplant may improve survival for patients with lupus nephritis

Abstract: http://annals.org/aim/article/doi/10.7326/M18-1570
Editorial: http://annals.org/aim/article/doi/10.7326/M18-3721
URLs go live when the embargo lifts

Patients with lupus nephritis and end stage renal disease may benefit from timely kidney transplant, as transplantation was associated with a significant increase in survival in a nationwide cohort study. The main reason for the overall survival benefit was fewer deaths due to cardiovascular disease and infections. The findings are published in Annals of Internal Medicine.

The risk for kidney failure from lupus nephritis is high and has not changed in the past 20 years, despite advances in diagnosis and treatment options. While renal transplantation has been associated with improved survival in the all-cause end stage renal disease population, clinicians proceed with caution for patients with lupus nephritis over fears of infection and other post-transplant complications.

Researchers from Massachusetts General Hospital studied a national database comprised of almost all patients with end stage renal disease to assess outcomes of patients with lupus nephritis who initiated dialysis and were placed on the waitlist for a kidney transplant. They found that transplant was associated with a 70 percent reduction in overall risk for death. The survival benefit persisted in key subgroups, including African Americans, Hispanics, and Asians, as well as in both sexes, in all age groups, and throughout the study period.

According to the authors of an accompanying editorial from Tufts Medical Center, these findings are strong and have implications for clinical practice. They say that kidney transplant should be part of the treatment plan for patients with lupus nephritis and should be emphasized before the onset of kidney failure. In addition, they suggest considering wider use of preemptive transplant in this population.

Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the lead author, April Jorge, MD, please contact AMJorge@mgh.harvard.edu. To speak with the lead editorialist, Nitender Goyal, MD, please contact Sue McGreevey at smcgreevey@partners.org

2. Recurrent strep infection leads to patient's debilitating muscle pain

Abstract: http://annals.org/aim/article/doi/10.7326/L18-0589
URLs go live when the embargo lifts

A patient with recurrent strep infection developed poststreptococcal myalgia and myositis (inflammation of the muscles), characterized by significant muscle pain and weakness. A biopsy confirmed muscle injury. Findings from a case report are published in Annals of Internal Medicine.

Streptococcal disease, or strep throat, has several immunologically mediated complications, including acute rheumatic fever, poststreptococcal glomerulonephritis (inflammation of the kidneys), and erythema nodosum (inflammation of the skin). Strep may have other complications that are less well-recognized.

Clinicians at Amsterdam UMC saw a 34-year-old man for his third episode of debilitating muscle pain after a sore throat. The bouts of severe muscle pain and weakness occurred in 2013, 2016, and 2018, each time following a throat infection. The patient was often unable to walk without assistance, but symptoms cleared up after a course of antibiotics and considering it was the third episode, the clinicians recommended starting penicillin prophylaxis.

According to the authors, 18 cases of postreptococcal polymyalgia and myositis have been published. Their case is unique because it is the only one with multiple recurrences, it is the only case with myositis confirmed by muscle biopsy, and it is the only one with laboratory signs of muscle injury. The authors suggest that treatment for patients with this type of strep complication could include high-dose acetylsalicylic acid, nonsteroidal anti-inflammatory drugs, penicillin, and prednisone.

Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the lead author, Marije K. Bomers, MD, PhD, please contact her PR office at communicatie@vumc.nl.
Also New in this issue: Perfect Compliance: The 2018 Accreditation Council for Graduate Medical Education Well-Being Survey
Christina M. Yuan, MD
Ideas and Opinions
Abstract: http://annals.org/aim/article/doi/10.7326/M18-2302

Caring for Patients With Multiple Chronic Conditions

Mary E. Tinetti, MD; Ariel R. Green, MD, MPH; Jennifer Ouellet, MD; Michael W. Rich, MD; and Cynthia Boyd, MD, MPH
Ideas and Opinions
Abstract: http://annals.org/aim/article/doi/10.7326/M18-3269

American College of Physicians

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