Browsing by Author "Naicker, S."

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    Important causes of chronic kidney disease in South Africa
    (Health & Medical Publishing Group, 2015) Moosa, M. R.; Van der Walt, I.; Naicker, S.; Meyers, A. M.
    In hypertensive patients without chronic kidney disease (CKD) the goal is to keep blood pressure (BP) at ≤140/90 mmHg. When CKD is present, especially where there is proteinuria of ≥0.5 g/day, the goal is a BP of ≤130/80 mmHg. Lifestyle measures are mandatory, especially limitation of salt intake, ingestion of adequate quantities of potassium, and weight control. Patients with stages 4 - 5 CKD must be carefully monitored for hyperkalaemia and deteriorating kidney function if angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) are used, especially in patients >60 years of age with diabetes or atherosclerosis. BP should be regularly monitored and, where possible, home BP-measuring devices are recommended for optimal control. Guidelines on the use of antidiabetic agents in CKD are presented, with the warning that metformin is contraindicated in patients with stages 4 - 5 CKD. There is a wide clinical spectrum of renal disease in the course of HIV infection, including acute kidney injury, electrolyte and acid-base disturbances, HIV-associated glomerular disease, acute-on-chronic renal disease and side-effects related to the treatment of HIV.
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    Mycophenolate mofetil versus cyclophosphamide for induction treatment of lupus nephritis
    (2009) Appel, G. B.; Contreras, G.; Dooley, M. A.; Ginzler, E. M.; Isenberg, D.; Jayne, D.; Li, L-S.; Mysler, E.; Sanchez-Guerrero, J.; Solomons, N.; Wofsy, D.; Abud, C.; Adler, S.; Alarcon, G.; Albuquerque, E.; Almeida, F.; Alvarellos, A.; Appel, G.; Avila, H.; Blume, C.; Boletis, I.; Bonnardeaux, A.; Braun, A.; Buyon, J.; Cervera, R.; Chen, N.; Chen, S.; Da Costa, A. G.; Davids, M. R.; D'Cruz, D.; De Ramon, E.; Deodhar, A.; Doria, A.; Dussol, B.; Emery, P.; Fiechtner, J.; Floege, J.; Fragoso-Loyo, H.; Furie, R.; Ghazalli, R.; Ghossein, C.; Gilkeson, G.; Ginzler, E.; Gordon, C.; Grossman, J.; Gu, J.; Guillevin, L.; Hatron, P. Y.; Herrera, G.; Hiepe, F.; Houssiau, F.; Hubscher, O.; Hura, C.; Kaplan, J.; Kirsztajn, G.; Kiss, E.; Kutty, G. A.; Laville, M.; Lazaro, M.; Lenz, O.; Li, L.; Lightstone, L.; Lim, S.; Malaise, M.; Manzi, S.; Marcos, J.; Meyer, O.; Monge, P.; Naicker, S.; Neal, N.; Neuwelt, M.; Nicholls, K.; Olsen, N.; Ordi-Ros, J.; Ostrov, B.; Pestana, M.; Petri, M.; Pokorny, G.; Pourrat, J.; Qian, J.; Radhakrishnan, J.; Rovin, B.; Roman, J. S.; Shanahan, J.; Shergy, W.; Skopouli, F.; Spindler, A.; Striebich, C.; Sundel, R.; Swanepoel, C.; Si, Y. T.; Tate, G.; Tesar, V.; Tikly, M.; Wang, H.; Yahya, R.; Yu, X.; Zhang, F.; Zoruba, D.
    Recent studies have suggested that mycophenolate mofetil (MMF) may offer advantages over intravenous cyclophosphamide (IVC) for the treatment of lupus nephritis, but these therapies have not been compared in an international randomized, controlled trial. Here, we report the comparison of MMF and IVC as induction treatment for active lupus nephritis in a multinational, two-phase (induction and maintenance) study. We randomly assigned 370 patients with classes III through V lupus nephritis to open-label MMF (target dosage 3 g/d) or IVC (0.5 to 1.0 g/m2 in monthly pulses) in a 24-wk induction study. Both groups received prednisone, tapered from a maximum starting dosage of 60 mg/d. The primary end point was a prespecified decrease in urine protein/creatinine ratio and stabilization or improvement in serum creatinine. Secondary end points included complete renal remission, systemic disease activity and damage, and safety. Overall, we did not detect a significantly different response rate between the two groups: 104 (56.2%) of 185 patients responded to MMF compared with 98 (53.0%) of 185 to IVC. Secondary end points were also similar between treatment groups. There were nine deaths in the MMF group and five in the IVC group. We did not detect significant differences between the MMF and IVC groups with regard to rates of adverse events, serious adverse events, or infections. Although most patients in both treatment groups experienced clinical improvement, the study did not meet its primary objective of showing that MMF was superior to IVC as induction treatment for lupus nephritis. Copyright © 2009 by the American Society of Nephrology.