Hydroxychloroquine use and blood pressure below 130/80 are associated with remission in lupus nephritis: A cohort study

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There is much to learn in systemic lupus erythematosus" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "107" "paginaFinal" => "108" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "De la oruga a la mariposa. Mucho que aprender en lupus eritematoso sistémico" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Gloria Vásquez" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Gloria" "apellidos" => "Vásquez" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0121812321001407?idApp=UINPBA00004N" "url" => "/01218123/00000028000000S2/v4_202404250921/S0121812321001407/v4_202404250921/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Hydroxychloroquine use and blood pressure below 130/80 are associated with remission in lupus nephritis: A cohort study" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "109" "paginaFinal" => "115" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Pablo Villa, Javier Darío Márquez-Hernández, Vladimir Duque, Carolina Muñoz-Grajales, Luis Fernando Pinto-Peñaranda, Miguel Antonio Mesa-Navas, Carlos Jaime Velásquez-Franco" "autores" => array:7 [ 0 => array:3 [ "nombre" => "Pablo" "apellidos" => "Villa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Javier Darío" "apellidos" => "Márquez-Hernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Vladimir" "apellidos" => "Duque" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Carolina" "apellidos" => "Muñoz-Grajales" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "Luis Fernando" "apellidos" => "Pinto-Peñaranda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "Miguel Antonio" "apellidos" => "Mesa-Navas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 6 => array:4 [ "nombre" => "Carlos Jaime" "apellidos" => "Velásquez-Franco" "email" => array:1 [ 0 => "carjaivel@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Internal Medicine Department, School of Health Sciences, Universidad Pontificia Bolivariana, Medellin, Colombia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Rheumatology Department, Hospital Pablo Tobón Uribe, Medellin, Colombia" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Epidemiology Department, School of Health Sciences, Universidad CES, Medellin, Colombia" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Immunology Department, School of Health Sciences, University of Toronto, Canada" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Rheumatology Department, School of Health Sciences, Clínica Universitaria Bolivariana, Universidad Pontificia Bolivariana, Medellin, Colombia" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El uso de hidroxicloroquina y las cifras de presión arterial por debajo de 130/80 se asocian con remisión en nefritis lúpica: un estudio de cohorte" ] ] "textoCompleto" => "IntroductionSystemic lupus erythematosus (SLE) is an autoimmune disease characterized by a chronic course and accumulated visceral damage.<a class="elsevierStyleCrossRef" href="#bib0165">1</a> One of the most frequently affected organs is the kidney, involved in up to 60% of the cases; this is one of the main markers of poor prognosis and mortality in this entity.<a class="elsevierStyleCrossRef" href="#bib0170">2</a>The mainstay of treatment in lupus nephritis (LN) is the use of immunosuppressants (cytotoxics between six and 12 months and high doses of glucocorticoids); unfortunately, the short- and long-term response rates to these regimens are less than 40%<a class="elsevierStyleCrossRef" href="#bib0175">3</a> Given this reality, different management guidelines (European League Against Rheumatism and American College of Rheumatology)<a class="elsevierStyleCrossRefs" href="#bib0180">4,5</a> propose the use of adjuvant therapies such as antimalarials, statins, blockade of the renin–angiotensin–aldosterone system, and the achievement of blood pressure levels lower than 130/80 to diminish intraglomerular pressure, preserve kidney function, prevent disease relapses, and reduce progression to end-stage kidney disease.<a class="elsevierStyleCrossRef" href="#bib0185">5</a>The evidence supporting these recommendations is scarce and is extrapolated from non-autoimmune kidney diseases (diabetes mellitus, arterial hypertension, dyslipidemia) and cardiovascular risk management in the general population<a class="elsevierStyleCrossRefs" href="#bib0190">6–9</a> and, until it is known, the frequency of use and the impact that this adjuvant therapy may have in individuals with LN in daily practice is unknown.The objective of this study was to estimate the frequency of use of adjuvant therapy in LN and determine whether its use has an impact on 12-month remission in a cohort of Latin American mestizo patients in two referral centers.Materials and methodsDesignAn analytical observational study of a retrospective cohort was carried out.ParticipantsAll patients with SLE older than 14 years of age, classified according to the 1999 modified American College of Rheumatology criteria,<a class="elsevierStyleCrossRef" href="#bib0210">10</a> with nephritis confirmed by biopsy according to the 2003 classification of the International Society of Nephrology and the Renal Pathology Society<a class="elsevierStyleCrossRef" href="#bib0215">11</a> attended in the outpatient and inpatient services, between 2005 and 2012, in two university hospitals of high-complexity level in northwestern Colombia. Patients with the absence of records in the medical charts of the variables of interest were excluded.All subjects received the remission induction scheme proposed by the LN treatment guidelines of the American College of Rheumatology.<a class="elsevierStyleCrossRef" href="#bib0185">5</a>As it was a pragmatic study, the decision to use cyclophosphamide or mycophenolate mofetil was left to the discretion of the treating physician. These subjects had a standard clinical and paraclinical follow-up for 12 months (calculation of glomerular filtration rate, measurement of urinary sediment, and 24-h proteinuria).Patients who did not achieve complete remission at 12 months were compared with those who accomplished this outcome. The definition of complete remission was adopted according to the AdHoc Subcommittee of the American College of Rheumatology on Lupus Nephritis criteria, as follows: glomerular filtration rate greater than or equal to 60mL/min/1.73m2, a 15% rise from baseline in those patients with glomerular filtration rate less than 60mL/min/1.73m2, proteinuria less than 0.5g/24h, inactive urinary sediment (less than five red blood cells, less than five leukocytes per high-power field and absence of hematic casts) and albumin serum greater than 3g/L.<a class="elsevierStyleCrossRef" href="#bib0220">12</a>VariablesThe variables of interest were the use of medications in more than 80% of the follow-up time: antimalarials (chloroquine or hydroxychloroquine), angiotensin-converting enzyme (ACE) inhibitors (enalapril or captopril), angiotensin receptor blockers (ARB) (losartan), use of statins (lovastatin, simvastatin, atorvastatin), and the achievement of blood pressure levels below 130/80.The data were obtained through the retrospective review of medical records, collected through a form previously established in a Microsoft Excel 2010 spreadsheet, with restriction of fields. All investigators received standard training before to the analysis of medical records and data collection.BiasesThe information on the variables of interest in the medical records was available in its entirety since the patient evaluation process is standardized in the places where the study was carried out. There were no losses to follow up. Since ACE inhibitors and ARB may have antiproteinuric and antihypertensive effects, their exact indication (antiproteinuric or antihypertensive) was taken into account from the data collection and analysis.Sample sizeThe population is made up of all the patients with LN followed up for at least one year during the study period.Statistical analysisFor the descriptive analysis of the quantitative variables, the measures of central tendency and dispersion were calculated, with their respective normality tests (Kolmogorov–Smirnov). The association between the variables of interest with the achievement of complete remission was determined using Pearson's Chi-square test. Association strengths odds ratio (OR) were calculated, with their respective confidence intervals (CI), with a level of 95%.The Mann–Whitney U test was used to establish the relationship between the type of adjuvant therapy and the quantitative variables with non-normal distribution; Student's t-test was used for variables with a normal distribution. Once the factors associated with the achievement of partial or complete remission at 12 months had been established, the multivariate logistic regression model was proposed. The type of multivariate analysis used was “backward”: all the variables were entered into the equation in the SPSS program and the variables that had the least partial correlation with the dependent variable were excluded. The goodness of the model was evaluated with the Hosmer and Lemeshow test.Ethical considerationsThe project was approved by the participating institutional ethics committees.ResultsGeneral characteristics167 potential patients were included. In all, their eligibility was confirmed through the inclusion and exclusion criteria; all subjects were analyzed. There were no missing data. The main characteristics of these patients are illustrated in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Adjuvant therapies in lupus nephritis142 subjects (85%) used antimalarials during the year of follow-up: 118 chloroquine and 24 hydroxychloroquine. Thus, 65.5% (n=73) of the individuals used ACE inhibitors (enalapril) and 4.5% (n=5) captopril, while 33.3% (n=56) received ARB (losartan). In the entire cohort, 30.7% of the subjects had a dual-axis block. The indications for these drugs were: antiproteinuric effect (62% for ACE inhibitors and 38% for ARB); in the rest of the patients, the indication for these drugs was as antihypertensive before the diagnosis of LN. Only 29.3% of the subjects (n=49) used statins. Eighty-five percent of the individuals achieved blood pressure values below 130/80 at one year of follow-up.Complete remission and association with adjuvant therapiesComplete remission at 12 months was only achieved in 39% of patients. In the bivariate analysis, the use of hydroxychloroquine and the achievement of blood pressure targets at 12 months were associated with the achievement of complete remission in this cohort, while the use of statins and ARB behaved as factors associated with failure in the achievement of remission (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>); in the multivariate analysis, the treatment with hydroxychloroquine and the achievement of blood pressure goals less than or equal to 130/80 were protective factors for failure to achieve remission at 12 months (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). No significant association was found between the achievement of remission at 12 months of LN with the use of chloroquine, ACE inhibitors, ARB, statins, and with the dual blockade of the renin–angiotensin–aldosterone axis. The association between use of statins and non-achievement of renal remission found in the bivariate analysis did not stay in the adjusted model.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia>The model was adjusted (p=0.908), but it explains only 13.3% of the variables that would be involved in the failure of therapy in these patients (Nagelkerke's R2=0.133).DiscussionThe most important findings found in this study were that the use of hydroxychloroquine and the achievement of blood pressure levels below 130/80 were associated with remission in a cohort of Latin American mestizo patients with LN.The renal protective effect of antimalarials in SLE patients has previously been demonstrated in several studies: Kasitanon et al. demonstrated that individuals with membranous nephritis treated with mycophenolate mofetil (MMF) were more likely to achieve remission after one year of treatment when they had also received hydroxychloroquine.<a class="elsevierStyleCrossRef" href="#bib0225">13</a> One of the strengths, in this regard, in our observational study, was that the protective effect of adjuvant therapies was independent of the cytotoxic drug used (cyclophosphamide or MMF). Supporting this beneficial effect, Barber et al. established that sustained renal remission (for at least three years after induction therapy) was more likely in subjects treated with hydroxychloroquine (93.8 vs 52.6%, p=0.010).<a class="elsevierStyleCrossRef" href="#bib0230">14</a>In the GLADEL cohort (Latin American Lupus Study Group), Pons-Estel et al. found that 64% of this cohort received hydroxychloroquine and a reduction in the rate of damage attributable to nephritis (OR 0.38, 95% CI: 0.25–0.58) was documented during a follow-up period of eight years.<a class="elsevierStyleCrossRef" href="#bib0235">15</a>Dall Era et al.<a class="elsevierStyleCrossRef" href="#bib0240">16</a> found that the non-use of hydroxychloroquine was associated with treatment failure in the ALMS study (Aspreva Lupus Management Study); furthermore, Pons-Estel et al., in the North American multicenter LUMINA cohort (LUpus in MInorities, NAture versus nurture) found that this drug was able to delay the appearance of proliferative nephritis and proteinuria for up to 2.5 years.<a class="elsevierStyleCrossRef" href="#bib0245">17</a>It is presumed that the pleiotropic effects of hydroxychloroquine: lipid-lowering, antiplatelet agents, inhibitors of Toll type 9 (TLR9) signaling, decreasing cytokine and prostaglandin production, inhibiting leukocyte activation, suppressing the presentation of autoantigens, decreasing the production of metalloproteases, in addition to their antiproliferative effects, would be responsible for a protective effect of the integrity and function in the glomeruli, avoiding the deposit of immune complexes, reducing oxidative stress and thus preventing organic damage.<a class="elsevierStyleCrossRef" href="#bib0250">18</a>It was also striking that the use of hydroxychloroquine, but not chloroquine in the present study, both drugs being from the same group, was associated with remission in these subjects. It should be clarified that most of the studies have been done with hydroxychloroquine and there seems to be a specific effect, since, in the present work, for example, most of the subjects received chloroquine, but there was no greater remission with its use. Only one study by Sisó et al. was found, in which previous exposure to both chloroquine and hydroxychloroquine was associated with less development of kidney failure, thrombosis, infections, and arterial hypertension; unfortunately, this study does not accurately express how many individuals specifically received chloroquine or hydroxychloroquine.<a class="elsevierStyleCrossRef" href="#bib0255">19</a>To date, it is not clear why hydroxychloroquine is more effective than chloroquine in NL; the biochemical and structural difference between both drugs would only account for fewer adverse effects; in 2010, a systematic review of antimalarials in SLE was carried out and most of the studies that support their beneficial effects in this entity were conducted with hydroxychloroquine.<a class="elsevierStyleCrossRef" href="#bib0260">20</a>We also want to highlight the finding that the achievement of blood pressure values below 130/80, as recommended by the LN treatment guidelines<a class="elsevierStyleCrossRef" href="#bib0180">4</a> was associated with remission. The literature so far published in this regard, concludes the same message, but reporting the finding as a risk factor, not as a protector; that is, arterial hypertension is a predictor of chronic renal failure in this group of patients.<a class="elsevierStyleCrossRefs" href="#bib0235">15,21,22</a> It should also be clarified that the design of these studies is different: the first was a prospective study; the second, similar to ours, was a nested case-control study; and the third is retrospective.It has also been reported that arterial hypertension is associated with an earlier appearance of nephritis<a class="elsevierStyleCrossRef" href="#bib0275">23</a>; besides, its inadequate control during the first year of treatment is an adverse prognostic factor in this disease.<a class="elsevierStyleCrossRef" href="#bib0280">24</a> These arguments speak of the importance of this clinical factor in the remission of lupus nephritis and support the results obtained in the present study. In this sense, it should be clarified that, due to the small number of individuals who received ACE or ARB, it is not possible to attribute blood pressure control to the use of these drugs; control of glomerulonephritis with immunosuppression could be responsible, for the most part, for this outcome.We also want to highlight the scarce publication that exists on the use of statins, ACE inhibitors, and ARB in LN; they appear in management guidelines<a class="elsevierStyleCrossRef" href="#bib0185">5</a> but are extrapolated from non-lupus nephropathies. To our knowledge, there is only one study of fluvastatin in murine models of LN in graft-versus-host disease, where reduction of the expression of the mitogen-activated protein kinase p38 (p38MAPK) was demonstrated.<a class="elsevierStyleCrossRef" href="#bib0285">25</a> In this study the use of statins was associated with non-achievement of remission of lupus nephritis in the bivariate analysis; however, this association did not stay in the multivariate model. The indication to use statins was hyperlipidemia maybe associated with nephrotic syndrome; thus, the association between statins and non-achievement of renal remission could be spurious. This topic must be explored in future studies.Regarding the antiproteinuric effect of blocking the renin–angiotensin–aldosterone axis, one of the first evidence was in silent nephritis, different from the proliferative nephritis analyzed in our study.<a class="elsevierStyleCrossRef" href="#bib0290">26</a> In 1990, a case of a 22-year-old patient with membranous lupus nephritis refractory to immunosuppressants with a reduction of proteinuria by more than 50% at 16 weeks with 125mg of captopril was reported.<a class="elsevierStyleCrossRef" href="#bib0295">27</a>There is also a retrospective report of seven patients with SLE who received enalapril 5mg and losartan 50mg for uncontrolled proteinuria; at 12 months, there was a reduction of this up to 84%, in addition to a reduction in blood pressure levels.<a class="elsevierStyleCrossRef" href="#bib0300">28</a>Durán-Barragán et al. found that the use of ACE inhibitors in the LUMINA cohort increased the probability of survival free of nephritis and disease activity; it should be noted that only 21% of these patients received ACE inhibitors. This study also does not clearly define the ACE inhibitor used, the dose, and the time of use before the development of nephritis, fundamental variables to establish any causal association.<a class="elsevierStyleCrossRef" href="#bib0305">29</a> In murine models of LN, there is also evidence of antiproteinuric efficacy and stabilization of renal function of aldosterone blockade with spironolactone, reducing the inflammatory response and apoptosis in the process of glomerulonephritis.<a class="elsevierStyleCrossRef" href="#bib0310">30</a>Furthermore, it is interesting to mention that the effect of these drugs is not only antihypertensive but probably immunomodulatory. Daza et al. evaluated 18 patients with LN, evaluating the nitrogen level and proteinuria; they showed that the combination of captopril and cyclophosphamide improved both outcomes at six months; this impact was independent of glomerular filtration rate or renal plasma flow; it is attributed to the reduction of urinary levels of PGE2.<a class="elsevierStyleCrossRef" href="#bib0315">31</a> In murine models of LN, a delay in the appearance of proteinuria has been demonstrated through the inhibition of TGF-beta, IL-4, and IL-10.<a class="elsevierStyleCrossRef" href="#bib0320">32</a>Several limitations of this study are recognized, most of them attributable to its retrospective design; the absence of long-term follow-up that demonstrates the persistence and consistency of the results found; the infrequent use of statins and dual blockade of the renin–angiotensin–aldosterone axis, which could explain the fact that no type of association was found with the clinical outcomes of interest, and even that OR behaved as a factor risk for failure to achieve remission in the bivariate analysis, a fact that has no biological plausibility and is explained by the phenomenon of reverse causality; this spurious association disappeared in the adjusted analysis.It is also recognized that the multicenter and multiethnic nature of cohorts such as GLADEL and LUMINA gives these studies greater precision and generalizability of the results.It is believed, however, that the results of this study can be generalized to Latin American mestizo patients with LN, since individuals from everyday clinical practice diagnosed with the gold standard (renal biopsy) were included, following the current classification (ISN/RPS 2003), and who were treated with conventional immunosuppressive regimens.ConclusionIn a cohort of patients with lupus nephritis, the use of hydroxychloroquine and achieving blood pressure values lower than 130/80 were associated with remission at 12 months.Declaration of conflicts of interest and funding sourcesThe authors declare that they have no conflicts of interest nor did they receive money from any institution. The participating institutions offered the research group all the logistical support necessary to carry out the data collection and preparation of the research article." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres2135010" "titulo" => "Abstract" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Materials and methods" ] 3 => array:2 [ "identificador" => "abst8015" "titulo" => "Outcomes" ] 4 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 5 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1812918" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2135009" "titulo" => "Resumen" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Materiales y métodos" ] 3 => array:2 [ "identificador" => "abst9040" "titulo" => "Desenlaces" ] 4 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 5 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1812919" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Design" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Participants" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Variables" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Biases" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Sample size" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Statistical analysis" ] 6 => array:2 [ "identificador" => "sec0045" "titulo" => "Ethical considerations" ] ] ] 6 => array:3 [ "identificador" => "sec0050" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "General characteristics" ] 1 => array:2 [ "identificador" => "sec0060" "titulo" => "Adjuvant therapies in lupus nephritis" ] 2 => array:2 [ "identificador" => "sec0065" "titulo" => "Complete remission and association with adjuvant therapies" ] ] ] 7 => array:2 [ "identificador" => "sec0070" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0075" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0080" "titulo" => "Declaration of conflicts of interest and funding sources" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-10-07" "fechaAceptado" => "2021-03-01" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1812918" "palabras" => array:9 [ 0 => "Adjuvants" 1 => "Pharmacist" 2 => "Antimalarials" 3 => "Angiotensin-converting enzyme inhibitors" 4 => "Angiotensin receptor antagonists" 5 => "Blood pressure" 6 => "Lupus erythematosus" 7 => "Systemic" 8 => "Nephritis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1812919" "palabras" => array:8 [ 0 => "Adyuvantes" 1 => "Farmacéutico" 2 => "Antimaláricos" 3 => "Inhibidores de la enzima convertidora de angiotensina" 4 => "Antagonistas de los receptores de angiotensina" 5 => "Presión arterial" 6 => "Lupus eritematoso sistémico" 7 => "Nefritis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionThe treatment of lupus nephritis, in addition to immunosuppression, includes the use of adjuvant therapies (antimalarials, statins, blockade of the renin–angiotensin system, and the achievement of blood pressure levels below 130/80). The evidence for the use of these strategies comes from non-autoimmune primary glomerulopathies and there is no information on their impact on the remission of this condition. ObjectiveTo determine, in patients with lupus nephritis, the use of adjuvant therapies and their association with remission at 12 months. Materials and methodsA retrospective cohort study was conducted, between 2005 and 2012. Patients who achieved complete remission of nephritis were compared with those who did not. Complete remission was defined by the American College of Rheumatology AdHoc Subcommittee. OutcomesPercentage of use of adjuvant therapies. Bivariate and multivariate analysis were performed to define association with remission. Results167 subjects were included (all eligible subjects); 85.6% used antimalarials, 65.5% angiotensin converting enzyme inhibitors, 33.5% angiotensin receptor blockers, 30.7% dual blockade, 29.3% statins, and 85% achieved the goal blood pressure. In the multivariate analysis, the use of hydroxychloroquine (OR=.149; 95% CI: .034–.647; p=.003) and the achievement of goal blood pressure (OR=.248; 95% CI: .1–.615; p=.003) were associated with remission. ConclusionsIn a cohort of patients with lupus nephritis, the use of hydroxychloroquine and achieving blood pressure values lower than 130/80 were associated with remission at 12 months." "secciones" => array:6 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Materials and methods" ] 3 => array:2 [ "identificador" => "abst8015" "titulo" => "Outcomes" ] 4 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 5 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónEl tratamiento de la nefritis lúpica, además de la inmunosupresión, comprende el uso de terapias adyuvantes (antimaláricos, estatinas, bloqueo del sistema renina angiotensina y el logro de cifras de presión arterial menores de 130/80). La evidencia del uso de estas estrategias proviene de glomerulopatías primarias no autoinmunes y no hay información de su impacto en la remisión de esta condición. ObjetivosDeterminar, en pacientes con nefritis lúpica, la utilización de terapias adyuvantes y su asociación con remisión a 12 meses. Materiales y métodosSe realizó un estudio de cohortes retrospectivo, entre 2005 y 2012. Se compararon los pacientes que lograron remisión completa de la nefritis con aquellos que no lo consiguieron. La remisión completa se definió según el Subcomité AdHoc del American College of Rheumatology. DesenlacesPorcentaje de utilización de terapias adyuvantes. Análisis: bivariado y multivariado para definir asociación con remisión. ResultadosSe incluyeron 167 pacientes (todos los sujetos elegibles). Un 85,6% utilizó antimaláricos, un 65,5% inhibidores de enzima convertidora de angiotensina, 33,5% bloqueadores del receptor de angiotensina, 30,7% bloqueo dual, 29,3% estatinas y en un 85% se logró la meta de presión arterial. En el análisis multivariado, el uso de hidroxicloroquina (OR=0,149; IC 95%: 0,034-0,647; p=0,003) y el logro de la meta de presión arterial (OR=0,248; IC 95%: 0,1-0,615; p=0,003) se asociaron a remisión. ConclusionesEn una cohorte de pacientes con nefritis lúpica, el uso de hidroxicloroquina y lograr cifras de presión arterial menores a 130/80 se asociaron a remisión a 12 meses." "secciones" => array:6 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Materiales y métodos" ] 3 => array:2 [ "identificador" => "abst9040" "titulo" => "Desenlaces" ] 4 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 5 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<elsevierMultimedia ident="upi0005"></elsevierMultimedia>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec1065" ] ] ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "141 patients with proliferative lupus nephritis were included.Abbreviations: SLE: systemic lupus erythematosus; NL: lupus nephritis." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Characteristic \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female gender (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83.9 (n=140) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age in years (mean and range) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24.7 (16–31) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Time elapsed between the diagnosis of SLE and LN (months) (median and interquartile range) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (0–35) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Proliferative lupus nephritis (class, % and N) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IV: 63.8 (107)III: 13.4 (22)V+III: 3.3 (6)V+IV: 3.3 (6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Induction therapy with cyclophosphamide (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Induction therapy with mycophenolate mofetil (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Arterial hypertension (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3519808.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Baseline characteristics of a cohort of 167 Latin American mestizo patients with lupus nephritis in northwestern Colombia." ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Abbreviations: ACE: angiotensin converting enzyme; ARB: angiotensin receptor blockers." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95% CI \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Use of chloroquine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.24–1.39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.262 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Use of hydroxychloroquine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.034–0.647 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.011 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Achievement of blood pressure figures less than 130/80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.1–0.615 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.003 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Use of ACE inhibitors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.308–1.163 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.17 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Use of ARB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.08–3.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0053 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Use of statins \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.81 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.42–5.54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.003 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3519806.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Factors associated with the absence of complete remission at 12 months in a cohort of patients with lupus nephritis (bivariate analysis)." ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Abbreviation: ACEIs: angiotensin converting enzyme inhibitors." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95% CI \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Use of chloroquine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.589 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.237–1.467 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.256 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Use of hydroxychloroquine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.181 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.040–0.813 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.026 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Achievement of blood pressure figures less than 130/80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.271 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.107–0.684 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.006 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Use of ACE inhibitors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.717 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.355–1.446 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.352 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3519807.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Factors associated with the absence of complete remission at 12 months in a cohort of patients with lupus nephritis (multivariate analysis)." ] ] 3 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.pdf" "ficheroTamanyo" => 137978 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:32 [ 0 => array:3 [ "identificador" => "bib0165" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lupus nephritis: from pathogenesis to targets for biologic treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Y. Liu" 1 => "H.J. Anders" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000368581" "Revista" => array:6 [ "tituloSerie" => "Nephron Clin Pract" "fecha" => "2014" "volumen" => "128" "paginaInicial" => "224" "paginaFinal" => "231" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25401461" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0170" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Immunosuppressive therapies for the induction treatment of proliferative lupus nephritis: a systematic review and network metaanalysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.Y. Tian" 1 => "B.M. Feldman" 2 => "J. Beyene" 3 => "P.E. Brown" 4 => "E.M. Uleryk" 5 => "E.D. Silverman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3899/jrheum.140050" "Revista" => array:6 [ "tituloSerie" => "J Rheumatol" "fecha" => "2014" "volumen" => "41" "paginaInicial" => "1998" "paginaFinal" => "2007" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25225281" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0175" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relative efficacy and safety of tacrolimus, mycophenolate mofetil, and cyclophosphamide as induction therapy for lupus nephritis: a Bayesian network meta-analysis of randomized controlled trials" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Y.H. Lee" 1 => "G.G. Song" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0961203315595131" "Revista" => array:6 [ "tituloSerie" => "Lupus" "fecha" => "2015" "volumen" => "24" "paginaInicial" => "1520" "paginaFinal" => "1528" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26162684" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0180" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and pediatric lupus nephritis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.K. Bertsias" 1 => "M. Tektonidou" 2 => "Z. Amoura" 3 => "M. Aringer" 4 => "I. Bajema" 5 => "J.H.M. Berden" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/annrheumdis-2012-201940" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2012" "volumen" => "71" "paginaInicial" => "1771" "paginaFinal" => "1782" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22851469" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0185" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "American College of Rheumatology guidelines for screening, treatment, and management of lupus nephritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "B.H. Hahn" 1 => "M.A. McMahon" 2 => "A. Wilkinson" 3 => "D. Wallace" 4 => "D.I. Daikh" 5 => "J.D. Fitzgerad" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/acr.21664" "Revista" => array:5 [ "tituloSerie" => "Arthritis Care Res" "fecha" => "2012" "volumen" => "64" "paginaInicial" => "797" "paginaFinal" => "808" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0190" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The 2009 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 2 – therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N.A. Khan" 1 => "B. Hemmelgarn" 2 => "R.J. Herman" 3 => "C.M. Bell" 4 => "J.L. Mahon" 5 => "L.A. Leiter" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0828-282x(09)70492-1" "Revista" => array:6 [ "tituloSerie" => "Can J Cardiol" "fecha" => "2009" "volumen" => "25" "paginaInicial" => "287" "paginaFinal" => "298" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19417859" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0195" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Meta-analysis: effect of monotherapy and combination therapy with inhibitors of the renin–angiotensin system on proteinuria in renal disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Kunz" 1 => "C. Friedrich" 2 => "M. Wolbers" 3 => "J.F.E. Mann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7326/0003-4819-148-1-200801010-00190" "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med" "fecha" => "2008" "volumen" => "148" "paginaInicial" => "30" "paginaFinal" => "48" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17984482" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0200" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Blood pressure lowering and major cardiovascular events in people with and without chronic kidney disease: meta-analysis of randomized controlled trials" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Blood Pressure Lowering Treatment Trialists’ Collaboration" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmj.f5680" "Revista" => array:5 [ "tituloSerie" => "BMJ" "fecha" => "2013" "volumen" => "347" "paginaInicial" => "f5680" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24092942" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0205" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "N.J. Stone" 1 => "J.G. Robinson" 2 => "A.H. Lichtenstein" 3 => "C.N. Bairey-Merz" 4 => "C.B. Blum" 5 => "R.H. Eckel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2013.11.002" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2014" "volumen" => "63" "paginaInicial" => "2889" "paginaFinal" => "2934" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24239923" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0210" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The American College of Rheumatology criteria for the classification of systemic lupus erythematosus: strengths, weaknesses, and opportunities for improvement" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L.E. Smith" 1 => "R.H. Shmerling" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1191/096120399680411317" "Revista" => array:6 [ "tituloSerie" => "Lupus" "fecha" => "1999" "volumen" => "8" "paginaInicial" => "586" "paginaFinal" => "595" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10568894" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0215" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The classification of glomerulonephritis in systemic lupus erythematosus revisited" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.J. Weening" 1 => "V.D. D’Agati" 2 => "M.M. Schwartz" 3 => "S.V. Seshan" 4 => "C.E. Alpers" 5 => "G.B. Appel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1523-1755.2004.00443.x" "Revista" => array:6 [ "tituloSerie" => "Kidney Int" "fecha" => "2004" "volumen" => "65" "paginaInicial" => "521" "paginaFinal" => "530" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14717922" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0220" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The American College of Rheumatology response criteria for proliferative and membranous renal disease in systemic lupus erythematosus clinical trials" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.H. Liang" 1 => "P.H. Schur" 2 => "P. Fortin" 3 => "St. Clair" 4 => "W. Balow" 5 => "J.E.K. Costenbader" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.21625" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "2006" "volumen" => "54" "paginaInicial" => "421" "paginaFinal" => "432" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16453282" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0225" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hydroxychloroquine use predicts complete renal remission within 12 months among patients treated with mycophenolate mofetil therapy for membranous lupus nephritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "N. Kasitanon" 1 => "D.M. Fine" 2 => "M. Haas" 3 => "L.S. Magder" 4 => "M. Petri" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1191/0961203306lu2313oa" "Revista" => array:6 [ "tituloSerie" => "Lupus" "fecha" => "2006" "volumen" => "15" "paginaInicial" => "366" "paginaFinal" => "370" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16830883" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0230" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sustained remission of lupus nephritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C.E.H. Barber" 1 => "L. Geldenhuys" 2 => "J.G. Hanly" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1191/0961203306lu2271oa" "Revista" => array:6 [ "tituloSerie" => "Lupus" "fecha" => "2006" "volumen" => "15" "paginaInicial" => "94" "paginaFinal" => "101" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16539280" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0235" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anti-malarials exert a protective effect while Mestizo patients are at increased risk of developing SLE renal disease: data from a Latin-American cohort" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G.J. Pons-Estel" 1 => "G.S. Alarcón" 2 => "L. Hachuel" 3 => "G. Boggio" 4 => "D. Wojdyla" 5 => "V. Pascual-Ramos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/rheumatology/ker514" "Revista" => array:6 [ "tituloSerie" => "Rheumatology" "fecha" => "2012" "volumen" => "51" "paginaInicial" => "1293" "paginaFinal" => "1298" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22389125" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0240" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Identification of clinical and serological factors during induction treatment of lupus nephritis that are associated with renal outcome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Dall’Era" 1 => "V. Levesque" 2 => "N. Solomons" 3 => "M. Truman" 4 => "D. Wofsy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/lupus-2015-000089" "Revista" => array:5 [ "tituloSerie" => "Lupus Sci Med" "fecha" => "2015" "volumen" => "2" "paginaInicial" => "e000089" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26023331" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0245" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Protective effect of hydroxychloroquine on renal damage in patients with lupus nephritis: LXV, data from a multiethnic US cohort" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.J. Pons-Estel" 1 => "G.S. Alarcón" 2 => "McGwin Jr." 3 => "M.I. Danila" 4 => "J. Zhang" 5 => "H.M. Bastian" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.24538" "Revista" => array:5 [ "tituloSerie" => "Arthritis Care Res" "fecha" => "2009" "volumen" => "61" "paginaInicial" => "830" "paginaFinal" => "839" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0250" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The role of antimalarial agents in the treatment of SLE and lupus nephritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.J. Lee" 1 => "E. Silverman" 2 => "J.M. Bargman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/nrneph.2011.150" "Revista" => array:6 [ "tituloSerie" => "Nat Rev Nephrol" "fecha" => "2011" "volumen" => "7" "paginaInicial" => "718" "paginaFinal" => "729" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22009248" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0255" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Previous antimalarial therapy in patients diagnosed with lupus nephritis: Influence on outcomes and survival" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Sisó" 1 => "M. Ramos-Casals" 2 => "A. Bove" 3 => "P. Brito-Zerón" 4 => "N. Soria" 5 => "S. Muñoz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0961203307086503" "Revista" => array:6 [ "tituloSerie" => "Lupus" "fecha" => "2008" "volumen" => "17" "paginaInicial" => "281" "paginaFinal" => "288" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18413408" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0260" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical efficacy and side effects of antimalarials in systemic lupus erythematosus: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G. Ruiz-Irastorza" 1 => "M. Ramos-Casals" 2 => "P. Brito-Zeron" 3 => "M.A. Khamashta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.2008.101766" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2010" "volumen" => "69" "paginaInicial" => "20" "paginaFinal" => "28" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19103632" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0265" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictors of poor renal outcome in patients with lupus nephritis treated with combined pulses of cyclophosphamide and methylprednisolone" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Cortés-Hernández" 1 => "J. Ordi-Ros" 2 => "M. Labrador" 3 => "A. Segarra" 4 => "J.L. Tovar" 5 => "E. Balada" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1191/0961203303lu340oa" "Revista" => array:6 [ "tituloSerie" => "Lupus" "fecha" => "2003" "volumen" => "12" "paginaInicial" => "287" "paginaFinal" => "296" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12729052" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0270" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The significance of arterial hypertension at the onset of clinical lupus nephritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "I.P. Naiker" 1 => "V. Chrystal" 2 => "I.G.H. Randeree" 3 => "Y.K. Seedat" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/pgmj.73.858.230" "Revista" => array:6 [ "tituloSerie" => "Postgrad Med J" "fecha" => "1997" "volumen" => "73" "paginaInicial" => "230" "paginaFinal" => "233" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9156126" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0275" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mestizos with systemic lupus erythematosus develop renal disease early while antimalarials retard its appearance: data from a Latin American cohort" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.J. Pons-Estel" 1 => "G.S. Alarcón" 2 => "P.I. Burgos" 3 => "L. Hachuel" 4 => "G. Boggio" 5 => "D. Wojdyla" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0961203313496339" "Revista" => array:6 [ "tituloSerie" => "Lupus" "fecha" => "2013" "volumen" => "22" "paginaInicial" => "899" "paginaFinal" => "907" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23857989" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0280" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prognostic factors in lupus nephritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C.C. Mok" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1191/0961203305lu2057a" "Revista" => array:6 [ "tituloSerie" => "Lupus" "fecha" => "2005" "volumen" => "14" "paginaInicial" => "39" "paginaFinal" => "44" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15732286" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0285" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of fluvastatin on expression of p38 mitogen-activated protein kinase in renal tissue of chronic graft versus host disease lupus nephritis in mice" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Q. Zhang" 1 => "M. Wang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Zhonghua Yi Xue Za Zhi" "fecha" => "2014" "volumen" => "94" "paginaInicial" => "1736" "paginaFinal" => "1739" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25151907" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0290" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Angiotensin inhibition or blockade for the treatment of patients with quiescent lupus nephritis and persistent proteinuria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "K.C. Tse" 1 => "F.K. Li" 2 => "S. Tang" 3 => "C.S.-O. Tang" 4 => "K.N. Lai" 5 => "T.M. Chan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1191/0961203305lu2249oa" "Revista" => array:6 [ "tituloSerie" => "Lupus" "fecha" => "2005" "volumen" => "14" "paginaInicial" => "947" "paginaFinal" => "952" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16425574" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0295" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antiproteinuric effect of captopril in a patient with lupus nephritis and intractable nephrotic syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Y. Shapira" 1 => "F. Mor" 2 => "A. Friedler" 3 => "A.J. Wysenbeek" 4 => "A. Weinberger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.49.9.725" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "1990" "volumen" => "49" "paginaInicial" => "725" "paginaFinal" => "727" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2241292" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0300" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antiproteinuric effect of angiotensin converting enzyme inhibitors and an angiotensin ii receptor blocker in patients with lupus nephritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N. Kitamura" 1 => "Y. Matsukawa" 2 => "M. Takei" 3 => "S. Sawada" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/147323000903700335" "Revista" => array:6 [ "tituloSerie" => "J Int Med Res" "fecha" => "2009" "volumen" => "37" "paginaInicial" => "892" "paginaFinal" => "898" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19589275" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0305" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Angiotensin-converting enzyme inhibitors delay the occurrence of renal involvement and are associated with a decreased risk of disease activity in patients with systemic lupus erythematosus — results from LUMINA (LIX): a multiethnic US cohort" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Durán-Barragán" 1 => "G. McGwin Jr." 2 => "L.M. Vilá" 3 => "J.D. Reveille" 4 => "G.S. Alarcón" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/rheumatology/ken208" "Revista" => array:5 [ "tituloSerie" => "Rheumatology" "fecha" => "2008" "volumen" => "47" "paginaInicial" => "1093" "paginaFinal" => "1096" ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0310" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The role of aldosterone blockade in murine lupus nephritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S.U. Monrad" 1 => "P.D. Killen" 2 => "M.R. Anderson" 3 => "A. Bradke" 4 => "M.J. Kaplan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/ar2353" "Revista" => array:5 [ "tituloSerie" => "Arthritis Res Ther" "fecha" => "2008" "volumen" => "10" "paginaInicial" => "R5" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18197980" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0315" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Captopril effect on prostaglandin E2, thromboxane B2 and proteinuria in lupus nephritis patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L. Daza" 1 => "C. Kornhauser" 2 => "L. Zamorac" 3 => "J. Flores" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.prostaglandins.2005.08.001" "Revista" => array:6 [ "tituloSerie" => "Prostaglandins Other Lipid Mediat" "fecha" => "2005" "volumen" => "78" "paginaInicial" => "194" "paginaFinal" => "201" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16303616" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0320" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "inhibitor reduces Th2 cytokines and TGF-β1 and TGF-β2 isoforms in murine lupus nephritis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.A. De Albuquerque" 1 => "V. Saxena" 2 => "D.E. Adams" 3 => "G.P. Boivin" 4 => "H.I. Brunner" 5 => "D.P. Witte" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1523-1755.2004.00462.x" "Revista" => array:6 [ "tituloSerie" => "Kidney Int" "fecha" => "2004" "volumen" => "65" "paginaInicial" => "846" "paginaFinal" => "859" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14871404" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/01218123/00000028000000S2/v4_202404250921/S0121812321000645/v4_202404250921/en/main.assets" "Apartado" => array:4 [ "identificador" => "95646" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/01218123/00000028000000S2/v4_202404250921/S0121812321000645/v4_202404250921/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0121812321000645?idApp=UINPBA00004N"]

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El uso de hidroxicloroquina y las cifras de presión arterial por debajo de 130/80 se asocian con remisión en nefritis lúpica: un estudio de cohorte

Pablo Villaa, Javier Darío Márquez-Hernándezb, Vladimir Duquec, Carolina Muñoz-Grajalesd, Luis Fernando Pinto-Peñarandab, Miguel Antonio Mesa-Navase, Carlos Jaime Velásquez-Francoe,

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carjaivel@gmail.com

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a Internal Medicine Department, School of Health Sciences, Universidad Pontificia Bolivariana, Medellin, Colombia

b Rheumatology Department, Hospital Pablo Tobón Uribe, Medellin, Colombia

c Epidemiology Department, School of Health Sciences, Universidad CES, Medellin, Colombia

d Immunology Department, School of Health Sciences, University of Toronto, Canada

e Rheumatology Department, School of Health Sciences, Clínica Universitaria Bolivariana, Universidad Pontificia Bolivariana, Medellin, Colombia

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        "titulo" => "El uso de hidroxicloroquina y las cifras de presi&#243;n arterial por debajo de 130&#47;80 se asocian con remisi&#243;n en nefritis l&#250;pica&#58; un estudio de cohorte"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Systemic lupus erythematosus &#40;SLE&#41; is an autoimmune disease characterized by a chronic course and accumulated visceral damage&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">1</span></a> One of the most frequently affected organs is the kidney&#44; involved in up to 60&#37; of the cases&#59; this is one of the main markers of poor prognosis and mortality in this entity&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The mainstay of treatment in lupus nephritis &#40;LN&#41; is the use of immunosuppressants &#40;cytotoxics between six and 12 months and high doses of glucocorticoids&#41;&#59; unfortunately&#44; the short- and long-term response rates to these regimens are less than 40&#37;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">3</span></a> Given this reality&#44; different management guidelines &#40;European League Against Rheumatism and American College of Rheumatology&#41;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">4&#44;5</span></a> propose the use of adjuvant therapies such as antimalarials&#44; statins&#44; blockade of the renin&#8211;angiotensin&#8211;aldosterone system&#44; and the achievement of blood pressure levels lower than 130&#47;80 to diminish intraglomerular pressure&#44; preserve kidney function&#44; prevent disease relapses&#44; and reduce progression to end-stage kidney disease&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The evidence supporting these recommendations is scarce and is extrapolated from non-autoimmune kidney diseases &#40;diabetes mellitus&#44; arterial hypertension&#44; dyslipidemia&#41; and cardiovascular risk management in the general population<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">6&#8211;9</span></a> and&#44; until it is known&#44; the frequency of use and the impact that this adjuvant therapy may have in individuals with LN in daily practice is unknown&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The objective of this study was to estimate the frequency of use of adjuvant therapy in LN and determine whether its use has an impact on 12-month remission in a cohort of Latin American mestizo patients in two referral centers&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Design</span><p id="par0025" class="elsevierStylePara elsevierViewall">An analytical observational study of a retrospective cohort was carried out&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Participants</span><p id="par0030" class="elsevierStylePara elsevierViewall">All patients with SLE older than 14 years of age&#44; classified according to the 1999 modified American College of Rheumatology criteria&#44;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">10</span></a> with nephritis confirmed by biopsy according to the 2003 classification of the International Society of Nephrology and the Renal Pathology Society<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">11</span></a> attended in the outpatient and inpatient services&#44; between 2005 and 2012&#44; in two university hospitals of high-complexity level in northwestern Colombia&#46; Patients with the absence of records in the medical charts of the variables of interest were excluded&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">All subjects received the remission induction scheme proposed by the LN treatment guidelines of the American College of Rheumatology&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">As it was a pragmatic study&#44; the decision to use cyclophosphamide or mycophenolate mofetil was left to the discretion of the treating physician&#46; These subjects had a standard clinical and paraclinical follow-up for 12 months &#40;calculation of glomerular filtration rate&#44; measurement of urinary sediment&#44; and 24-h proteinuria&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Patients who did not achieve complete remission at 12 months were compared with those who accomplished this outcome&#46; The definition of complete remission was adopted according to the AdHoc Subcommittee of the American College of Rheumatology on Lupus Nephritis criteria&#44; as follows&#58; glomerular filtration rate greater than or equal to 60<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#44; a 15&#37; rise from baseline in those patients with glomerular filtration rate less than 60<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#44; proteinuria less than 0&#46;5<span class="elsevierStyleHsp" style=""></span>g&#47;24<span class="elsevierStyleHsp" style=""></span>h&#44; inactive urinary sediment &#40;less than five red blood cells&#44; less than five leukocytes per high-power field and absence of hematic casts&#41; and albumin serum greater than 3<span class="elsevierStyleHsp" style=""></span>g&#47;L&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">12</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Variables</span><p id="par0050" class="elsevierStylePara elsevierViewall">The variables of interest were the use of medications in more than 80&#37; of the follow-up time&#58; antimalarials &#40;chloroquine or hydroxychloroquine&#41;&#44; angiotensin-converting enzyme &#40;ACE&#41; inhibitors &#40;enalapril or captopril&#41;&#44; angiotensin receptor blockers &#40;ARB&#41; &#40;losartan&#41;&#44; use of statins &#40;lovastatin&#44; simvastatin&#44; atorvastatin&#41;&#44; and the achievement of blood pressure levels below 130&#47;80&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The data were obtained through the retrospective review of medical records&#44; collected through a form previously established in a Microsoft Excel 2010 spreadsheet&#44; with restriction of fields&#46; All investigators received standard training before to the analysis of medical records and data collection&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Biases</span><p id="par0060" class="elsevierStylePara elsevierViewall">The information on the variables of interest in the medical records was available in its entirety since the patient evaluation process is standardized in the places where the study was carried out&#46; There were no losses to follow up&#46; Since ACE inhibitors and ARB may have antiproteinuric and antihypertensive effects&#44; their exact indication &#40;antiproteinuric or antihypertensive&#41; was taken into account from the data collection and analysis&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Sample size</span><p id="par0065" class="elsevierStylePara elsevierViewall">The population is made up of all the patients with LN followed up for at least one year during the study period&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Statistical analysis</span><p id="par0070" class="elsevierStylePara elsevierViewall">For the descriptive analysis of the quantitative variables&#44; the measures of central tendency and dispersion were calculated&#44; with their respective normality tests &#40;Kolmogorov&#8211;Smirnov&#41;&#46; The association between the variables of interest with the achievement of complete remission was determined using Pearson&#39;s Chi-square test&#46; Association strengths odds ratio &#40;OR&#41; were calculated&#44; with their respective confidence intervals &#40;CI&#41;&#44; with a level of 95&#37;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test was used to establish the relationship between the type of adjuvant therapy and the quantitative variables with non-normal distribution&#59; Student&#39;s <span class="elsevierStyleItalic">t</span>-test was used for variables with a normal distribution&#46; Once the factors associated with the achievement of partial or complete remission at 12 months had been established&#44; the multivariate logistic regression model was proposed&#46; The type of multivariate analysis used was &#8220;backward&#8221;&#58; all the variables were entered into the equation in the SPSS program and the variables that had the least partial correlation with the dependent variable were excluded&#46; The goodness of the model was evaluated with the Hosmer and Lemeshow test&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Ethical considerations</span><p id="par0080" class="elsevierStylePara elsevierViewall">The project was approved by the participating institutional ethics committees&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Results</span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">General characteristics</span><p id="par0085" class="elsevierStylePara elsevierViewall">167 potential patients were included&#46; In all&#44; their eligibility was confirmed through the inclusion and exclusion criteria&#59; all subjects were analyzed&#46; There were no missing data&#46; The main characteristics of these patients are illustrated in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Adjuvant therapies in lupus nephritis</span><p id="par0090" class="elsevierStylePara elsevierViewall">142 subjects &#40;85&#37;&#41; used antimalarials during the year of follow-up&#58; 118 chloroquine and 24 hydroxychloroquine&#46; Thus&#44; 65&#46;5&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>73&#41; of the individuals used ACE inhibitors &#40;enalapril&#41; and 4&#46;5&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41; captopril&#44; while 33&#46;3&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>56&#41; received ARB &#40;losartan&#41;&#46; In the entire cohort&#44; 30&#46;7&#37; of the subjects had a dual-axis block&#46; The indications for these drugs were&#58; antiproteinuric effect &#40;62&#37; for ACE inhibitors and 38&#37; for ARB&#41;&#59; in the rest of the patients&#44; the indication for these drugs was as antihypertensive before the diagnosis of LN&#46; Only 29&#46;3&#37; of the subjects &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>49&#41; used statins&#46; Eighty-five percent of the individuals achieved blood pressure values below 130&#47;80 at one year of follow-up&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Complete remission and association with adjuvant therapies</span><p id="par0095" class="elsevierStylePara elsevierViewall">Complete remission at 12 months was only achieved in 39&#37; of patients&#46; In the bivariate analysis&#44; the use of hydroxychloroquine and the achievement of blood pressure targets at 12 months were associated with the achievement of complete remission in this cohort&#44; while the use of statins and ARB behaved as factors associated with failure in the achievement of remission &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#59; in the multivariate analysis&#44; the treatment with hydroxychloroquine and the achievement of blood pressure goals less than or equal to 130&#47;80 were protective factors for failure to achieve remission at 12 months &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; No significant association was found between the achievement of remission at 12 months of LN with the use of chloroquine&#44; ACE inhibitors&#44; ARB&#44; statins&#44; and with the dual blockade of the renin&#8211;angiotensin&#8211;aldosterone axis&#46; The association between use of statins and non-achievement of renal remission found in the bivariate analysis did not stay in the adjusted model&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">The model was adjusted &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;908&#41;&#44; but it explains only 13&#46;3&#37; of the variables that would be involved in the failure of therapy in these patients &#40;Nagelkerke&#39;s <span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;133&#41;&#46;</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">The most important findings found in this study were that the use of hydroxychloroquine and the achievement of blood pressure levels below 130&#47;80 were associated with remission in a cohort of Latin American mestizo patients with LN&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The renal protective effect of antimalarials in SLE patients has previously been demonstrated in several studies&#58; Kasitanon et al&#46; demonstrated that individuals with membranous nephritis treated with mycophenolate mofetil &#40;MMF&#41; were more likely to achieve remission after one year of treatment when they had also received hydroxychloroquine&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">13</span></a> One of the strengths&#44; in this regard&#44; in our observational study&#44; was that the protective effect of adjuvant therapies was independent of the cytotoxic drug used &#40;cyclophosphamide or MMF&#41;&#46; Supporting this beneficial effect&#44; Barber et al&#46; established that sustained renal remission &#40;for at least three years after induction therapy&#41; was more likely in subjects treated with hydroxychloroquine &#40;93&#46;8 vs 52&#46;6&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;010&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">14</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">In the GLADEL cohort &#40;Latin American Lupus Study Group&#41;&#44; Pons-Estel et al&#46; found that 64&#37; of this cohort received hydroxychloroquine and a reduction in the rate of damage attributable to nephritis &#40;OR 0&#46;38&#44; 95&#37; CI&#58; 0&#46;25&#8211;0&#46;58&#41; was documented during a follow-up period of eight years&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">15</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Dall Era et al&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">16</span></a> found that the non-use of hydroxychloroquine was associated with treatment failure in the ALMS study &#40;Aspreva Lupus Management Study&#41;&#59; furthermore&#44; Pons-Estel et al&#46;&#44; in the North American multicenter LUMINA cohort &#40;LUpus in MInorities&#44; NAture versus nurture&#41; found that this drug was able to delay the appearance of proliferative nephritis and proteinuria for up to 2&#46;5 years&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">17</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">It is presumed that the pleiotropic effects of hydroxychloroquine&#58; lipid-lowering&#44; antiplatelet agents&#44; inhibitors of Toll type 9 &#40;TLR9&#41; signaling&#44; decreasing cytokine and prostaglandin production&#44; inhibiting leukocyte activation&#44; suppressing the presentation of autoantigens&#44; decreasing the production of metalloproteases&#44; in addition to their antiproliferative effects&#44; would be responsible for a protective effect of the integrity and function in the glomeruli&#44; avoiding the deposit of immune complexes&#44; reducing oxidative stress and thus preventing organic damage&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">18</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">It was also striking that the use of hydroxychloroquine&#44; but not chloroquine in the present study&#44; both drugs being from the same group&#44; was associated with remission in these subjects&#46; It should be clarified that most of the studies have been done with hydroxychloroquine and there seems to be a specific effect&#44; since&#44; in the present work&#44; for example&#44; most of the subjects received chloroquine&#44; but there was no greater remission with its use&#46; Only one study by Sis&#243; et al&#46; was found&#44; in which previous exposure to both chloroquine and hydroxychloroquine was associated with less development of kidney failure&#44; thrombosis&#44; infections&#44; and arterial hypertension&#59; unfortunately&#44; this study does not accurately express how many individuals specifically received chloroquine or hydroxychloroquine&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">19</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">To date&#44; it is not clear why hydroxychloroquine is more effective than chloroquine in NL&#59; the biochemical and structural difference between both drugs would only account for fewer adverse effects&#59; in 2010&#44; a systematic review of antimalarials in SLE was carried out and most of the studies that support their beneficial effects in this entity were conducted with hydroxychloroquine&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">20</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">We also want to highlight the finding that the achievement of blood pressure values below 130&#47;80&#44; as recommended by the LN treatment guidelines<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">4</span></a> was associated with remission&#46; The literature so far published in this regard&#44; concludes the same message&#44; but reporting the finding as a risk factor&#44; not as a protector&#59; that is&#44; arterial hypertension is a predictor of chronic renal failure in this group of patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">15&#44;21&#44;22</span></a> It should also be clarified that the design of these studies is different&#58; the first was a prospective study&#59; the second&#44; similar to ours&#44; was a nested case-control study&#59; and the third is retrospective&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">It has also been reported that arterial hypertension is associated with an earlier appearance of nephritis<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">23</span></a>&#59; besides&#44; its inadequate control during the first year of treatment is an adverse prognostic factor in this disease&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">24</span></a> These arguments speak of the importance of this clinical factor in the remission of lupus nephritis and support the results obtained in the present study&#46; In this sense&#44; it should be clarified that&#44; due to the small number of individuals who received ACE or ARB&#44; it is not possible to attribute blood pressure control to the use of these drugs&#59; control of glomerulonephritis with immunosuppression could be responsible&#44; for the most part&#44; for this outcome&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">We also want to highlight the scarce publication that exists on the use of statins&#44; ACE inhibitors&#44; and ARB in LN&#59; they appear in management guidelines<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">5</span></a> but are extrapolated from non-lupus nephropathies&#46; To our knowledge&#44; there is only one study of fluvastatin in murine models of LN in graft-versus-host disease&#44; where reduction of the expression of the mitogen-activated protein kinase p38 &#40;p38MAPK&#41; was demonstrated&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">25</span></a> In this study the use of statins was associated with non-achievement of remission of lupus nephritis in the bivariate analysis&#59; however&#44; this association did not stay in the multivariate model&#46; The indication to use statins was hyperlipidemia maybe associated with nephrotic syndrome&#59; thus&#44; the association between statins and non-achievement of renal remission could be spurious&#46; This topic must be explored in future studies&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Regarding the antiproteinuric effect of blocking the renin&#8211;angiotensin&#8211;aldosterone axis&#44; one of the first evidence was in silent nephritis&#44; different from the proliferative nephritis analyzed in our study&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">26</span></a> In 1990&#44; a case of a 22-year-old patient with membranous lupus nephritis refractory to immunosuppressants with a reduction of proteinuria by more than 50&#37; at 16 weeks with 125<span class="elsevierStyleHsp" style=""></span>mg of captopril was reported&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">27</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">There is also a retrospective report of seven patients with SLE who received enalapril 5<span class="elsevierStyleHsp" style=""></span>mg and losartan 50<span class="elsevierStyleHsp" style=""></span>mg for uncontrolled proteinuria&#59; at 12 months&#44; there was a reduction of this up to 84&#37;&#44; in addition to a reduction in blood pressure levels&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">28</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">Dur&#225;n-Barrag&#225;n et al&#46; found that the use of ACE inhibitors in the LUMINA cohort increased the probability of survival free of nephritis and disease activity&#59; it should be noted that only 21&#37; of these patients received ACE inhibitors&#46; This study also does not clearly define the ACE inhibitor used&#44; the dose&#44; and the time of use before the development of nephritis&#44; fundamental variables to establish any causal association&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">29</span></a> In murine models of LN&#44; there is also evidence of antiproteinuric efficacy and stabilization of renal function of aldosterone blockade with spironolactone&#44; reducing the inflammatory response and apoptosis in the process of glomerulonephritis&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">30</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">Furthermore&#44; it is interesting to mention that the effect of these drugs is not only antihypertensive but probably immunomodulatory&#46; Daza et al&#46; evaluated 18 patients with LN&#44; evaluating the nitrogen level and proteinuria&#59; they showed that the combination of captopril and cyclophosphamide improved both outcomes at six months&#59; this impact was independent of glomerular filtration rate or renal plasma flow&#59; it is attributed to the reduction of urinary levels of PGE2&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">31</span></a> In murine models of LN&#44; a delay in the appearance of proteinuria has been demonstrated through the inhibition of TGF-beta&#44; IL-4&#44; and IL-10&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">32</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Several limitations of this study are recognized&#44; most of them attributable to its retrospective design&#59; the absence of long-term follow-up that demonstrates the persistence and consistency of the results found&#59; the infrequent use of statins and dual blockade of the renin&#8211;angiotensin&#8211;aldosterone axis&#44; which could explain the fact that no type of association was found with the clinical outcomes of interest&#44; and even that OR behaved as a factor risk for failure to achieve remission in the bivariate analysis&#44; a fact that has no biological plausibility and is explained by the phenomenon of reverse causality&#59; this spurious association disappeared in the adjusted analysis&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">It is also recognized that the multicenter and multiethnic nature of cohorts such as GLADEL and LUMINA gives these studies greater precision and generalizability of the results&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">It is believed&#44; however&#44; that the results of this study can be generalized to Latin American mestizo patients with LN&#44; since individuals from everyday clinical practice diagnosed with the gold standard &#40;renal biopsy&#41; were included&#44; following the current classification &#40;ISN&#47;RPS 2003&#41;&#44; and who were treated with conventional immunosuppressive regimens&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conclusion</span><p id="par0190" class="elsevierStylePara elsevierViewall">In a cohort of patients with lupus nephritis&#44; the use of hydroxychloroquine and achieving blood pressure values lower than 130&#47;80 were associated with remission at 12 months&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Declaration of conflicts of interest and funding sources</span><p id="par0195" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest nor did they receive money from any institution&#46; The participating institutions offered the research group all the logistical support necessary to carry out the data collection and preparation of the research article&#46;</p></span></span>"
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              "titulo" => "Adjuvant therapies in lupus nephritis"
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            2 => "Antimalarials"
            3 => "Angiotensin-converting enzyme inhibitors"
            4 => "Angiotensin receptor antagonists"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The treatment of lupus nephritis&#44; in addition to immunosuppression&#44; includes the use of adjuvant therapies &#40;antimalarials&#44; statins&#44; blockade of the renin&#8211;angiotensin system&#44; and the achievement of blood pressure levels below 130&#47;80&#41;&#46; The evidence for the use of these strategies comes from non-autoimmune primary glomerulopathies and there is no information on their impact on the remission of this condition&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To determine&#44; in patients with lupus nephritis&#44; the use of adjuvant therapies and their association with remission at 12 months&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Materials and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A retrospective cohort study was conducted&#44; between 2005 and 2012&#46; Patients who achieved complete remission of nephritis were compared with those who did not&#46; Complete remission was defined by the American College of Rheumatology AdHoc Subcommittee&#46;</p></span> <span id="abst8015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect8020">Outcomes</span><p id="spar9015" class="elsevierStyleSimplePara elsevierViewall">Percentage of use of adjuvant therapies&#46; Bivariate and multivariate analysis were performed to define association with remission&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">167 subjects were included &#40;all eligible subjects&#41;&#59; 85&#46;6&#37; used antimalarials&#44; 65&#46;5&#37; angiotensin converting enzyme inhibitors&#44; 33&#46;5&#37; angiotensin receptor blockers&#44; 30&#46;7&#37; dual blockade&#44; 29&#46;3&#37; statins&#44; and 85&#37; achieved the goal blood pressure&#46; In the multivariate analysis&#44; the use of hydroxychloroquine &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;149&#59; 95&#37; CI&#58; &#46;034&#8211;&#46;647&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;003&#41; and the achievement of goal blood pressure &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;248&#59; 95&#37; CI&#58; &#46;1&#8211;&#46;615&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;003&#41; were associated with remission&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">In a cohort of patients with lupus nephritis&#44; the use of hydroxychloroquine and achieving blood pressure values lower than 130&#47;80 were associated with remission at 12 months&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El tratamiento de la nefritis l&#250;pica&#44; adem&#225;s de la inmunosupresi&#243;n&#44; comprende el uso de terapias adyuvantes &#40;antimal&#225;ricos&#44; estatinas&#44; bloqueo del sistema renina angiotensina y el logro de cifras de presi&#243;n arterial menores de 130&#47;80&#41;&#46; La evidencia del uso de estas estrategias proviene de glomerulopat&#237;as primarias no autoinmunes y no hay informaci&#243;n de su impacto en la remisi&#243;n de esta condici&#243;n&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivos</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Determinar&#44; en pacientes con nefritis l&#250;pica&#44; la utilizaci&#243;n de terapias adyuvantes y su asociaci&#243;n con remisi&#243;n a 12 meses&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Materiales y m&#233;todos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio de cohortes retrospectivo&#44; entre 2005 y 2012&#46; Se compararon los pacientes que lograron remisi&#243;n completa de la nefritis con aquellos que no lo consiguieron&#46; La remisi&#243;n completa se defini&#243; seg&#250;n el Subcomit&#233; AdHoc del American College of Rheumatology&#46;</p></span> <span id="abst9040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect8050">Desenlaces</span><p id="spar7035" class="elsevierStyleSimplePara elsevierViewall">Porcentaje de utilizaci&#243;n de terapias adyuvantes&#46; An&#225;lisis&#58; bivariado y multivariado para definir asociaci&#243;n con remisi&#243;n&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 167 pacientes &#40;todos los sujetos elegibles&#41;&#46; Un 85&#44;6&#37; utiliz&#243; antimal&#225;ricos&#44; un 65&#44;5&#37; inhibidores de enzima convertidora de angiotensina&#44; 33&#44;5&#37; bloqueadores del receptor de angiotensina&#44; 30&#44;7&#37; bloqueo dual&#44; 29&#44;3&#37; estatinas y en un 85&#37; se logr&#243; la meta de presi&#243;n arterial&#46; En el an&#225;lisis multivariado&#44; el uso de hidroxicloroquina &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;149&#59; IC 95&#37;&#58; 0&#44;034-0&#44;647&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41; y el logro de la meta de presi&#243;n arterial &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;248&#59; IC 95&#37;&#58; 0&#44;1-0&#44;615&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41; se asociaron a remisi&#243;n&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">En una cohorte de pacientes con nefritis l&#250;pica&#44; el uso de hidroxicloroquina y lograr cifras de presi&#243;n arterial menores a 130&#47;80 se asociaron a remisi&#243;n a 12 meses&#46;</p></span>"
        "secciones" => array:6 [
          0 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Objetivos"
          ]
          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Materiales y m&#233;todos"
          ]
          3 => array:2 [
            "identificador" => "abst9040"
            "titulo" => "Desenlaces"
          ]
          4 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Resultados"
          ]
          5 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par1175" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec1065"
          ]
        ]
      ]
    ]
    "multimedia" => array:4 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">141 patients with proliferative lupus nephritis were included&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; SLE&#58; systemic lupus erythematosus&#59; NL&#58; lupus nephritis&#46;</p>"
          "tablatextoimagen" => array:1 [
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Characteristic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female gender &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83&#46;9 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>140&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age in years &#40;mean and range&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#46;7 &#40;16&#8211;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Time elapsed between the diagnosis of SLE and LN &#40;months&#41; &#40;median and interquartile range&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;0&#8211;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Proliferative lupus nephritis &#40;class&#44; &#37; and <span class="elsevierStyleItalic">N</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IV&#58; 63&#46;8 &#40;107&#41;III&#58; 13&#46;4 &#40;22&#41;V<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>III&#58; 3&#46;3 &#40;6&#41;V<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>IV&#58; 3&#46;3 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Induction therapy with cyclophosphamide &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Induction therapy with mycophenolate mofetil &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Arterial hypertension &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3519808.png"
              ]
            ]
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Baseline characteristics of a cohort of 167 Latin American mestizo patients with lupus nephritis in northwestern Colombia&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; ACE&#58; angiotensin converting enzyme&#59; ARB&#58; angiotensin receptor blockers&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use of chloroquine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;24&#8211;1&#46;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;262&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use of hydroxychloroquine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">0&#46;15</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">0&#46;034&#8211;0&#46;647</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Achievement of blood pressure figures less than 130&#47;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">0&#46;25</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">0&#46;1&#8211;0&#46;615</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use of ACE inhibitors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;308&#8211;1&#46;163&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use of ARB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;08&#8211;3&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;0053&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use of statins&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;42&#8211;5&#46;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Lupus nephritis&#58; from pathogenesis to targets for biologic treatment"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:2 [
                            0 => "Y&#46; Liu"
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                          ]
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                    0 => array:2 [
                      "doi" => "10.1159/000368581"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nephron Clin Pract"
                        "fecha" => "2014"
                        "volumen" => "128"
                        "paginaInicial" => "224"
                        "paginaFinal" => "231"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25401461"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0170"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Immunosuppressive therapies for the induction treatment of proliferative lupus nephritis&#58; a systematic review and network metaanalysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46;Y&#46; Tian"
                            1 => "B&#46;M&#46; Feldman"
                            2 => "J&#46; Beyene"
                            3 => "P&#46;E&#46; Brown"
                            4 => "E&#46;M&#46; Uleryk"
                            5 => "E&#46;D&#46; Silverman"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.3899/jrheum.140050"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Rheumatol"
                        "fecha" => "2014"
                        "volumen" => "41"
                        "paginaInicial" => "1998"
                        "paginaFinal" => "2007"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25225281"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
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              "etiqueta" => "3"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Relative efficacy and safety of tacrolimus&#44; mycophenolate mofetil&#44; and cyclophosphamide as induction therapy for lupus nephritis&#58; a Bayesian network meta-analysis of randomized controlled trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Y&#46;H&#46; Lee"
                            1 => "G&#46;G&#46; Song"
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                        ]
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                    ]
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                    0 => array:2 [
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                        "tituloSerie" => "Lupus"
                        "fecha" => "2015"
                        "volumen" => "24"
                        "paginaInicial" => "1520"
                        "paginaFinal" => "1528"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26162684"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association &#40;EULAR&#47;ERA-EDTA&#41; recommendations for the management of adult and pediatric lupus nephritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46;K&#46; Bertsias"
                            1 => "M&#46; Tektonidou"
                            2 => "Z&#46; Amoura"
                            3 => "M&#46; Aringer"
                            4 => "I&#46; Bajema"
                            5 => "J&#46;H&#46;M&#46; Berden"
                          ]
                        ]
                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1136/annrheumdis-2012-201940"
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                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2012"
                        "volumen" => "71"
                        "paginaInicial" => "1771"
                        "paginaFinal" => "1782"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22851469"
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                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "American College of Rheumatology guidelines for screening&#44; treatment&#44; and management of lupus nephritis"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "B&#46;H&#46; Hahn"
                            1 => "M&#46;A&#46; McMahon"
                            2 => "A&#46; Wilkinson"
                            3 => "D&#46; Wallace"
                            4 => "D&#46;I&#46; Daikh"
                            5 => "J&#46;D&#46; Fitzgerad"
                          ]
                        ]
                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1002/acr.21664"
                      "Revista" => array:5 [
                        "tituloSerie" => "Arthritis Care Res"
                        "fecha" => "2012"
                        "volumen" => "64"
                        "paginaInicial" => "797"
                        "paginaFinal" => "808"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The 2009 Canadian Hypertension Education Program recommendations for the management of hypertension&#58; Part 2 &#8211; therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46;A&#46; Khan"
                            1 => "B&#46; Hemmelgarn"
                            2 => "R&#46;J&#46; Herman"
                            3 => "C&#46;M&#46; Bell"
                            4 => "J&#46;L&#46; Mahon"
                            5 => "L&#46;A&#46; Leiter"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0828-282x(09)70492-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Can J Cardiol"
                        "fecha" => "2009"
                        "volumen" => "25"
                        "paginaInicial" => "287"
                        "paginaFinal" => "298"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19417859"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Meta-analysis&#58; effect of monotherapy and combination therapy with inhibitors of the renin&#8211;angiotensin system on proteinuria in renal disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46; Kunz"
                            1 => "C&#46; Friedrich"
                            2 => "M&#46; Wolbers"
                            3 => "J&#46;F&#46;E&#46; Mann"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.7326/0003-4819-148-1-200801010-00190"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "2008"
                        "volumen" => "148"
                        "paginaInicial" => "30"
                        "paginaFinal" => "48"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17984482"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Blood pressure lowering and major cardiovascular events in people with and without chronic kidney disease&#58; meta-analysis of randomized controlled trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "Blood Pressure Lowering Treatment Trialists&#8217; Collaboration"
                          "etal" => false
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmj.f5680"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2013"
                        "volumen" => "347"
                        "paginaInicial" => "f5680"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24092942"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0205"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2013 ACC&#47;AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "N&#46;J&#46; Stone"
                            1 => "J&#46;G&#46; Robinson"
                            2 => "A&#46;H&#46; Lichtenstein"
                            3 => "C&#46;N&#46; Bairey-Merz"
                            4 => "C&#46;B&#46; Blum"
                            5 => "R&#46;H&#46; Eckel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2013.11.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2014"
                        "volumen" => "63"
                        "paginaInicial" => "2889"
                        "paginaFinal" => "2934"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24239923"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0210"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The American College of Rheumatology criteria for the classification of systemic lupus erythematosus&#58; strengths&#44; weaknesses&#44; and opportunities for improvement"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46;E&#46; Smith"
                            1 => "R&#46;H&#46; Shmerling"
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                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1191/096120399680411317"
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                        "tituloSerie" => "Lupus"
                        "fecha" => "1999"
                        "volumen" => "8"
                        "paginaInicial" => "586"
                        "paginaFinal" => "595"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10568894"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0215"
              "etiqueta" => "11"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The classification of glomerulonephritis in systemic lupus erythematosus revisited"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;J&#46; Weening"
                            1 => "V&#46;D&#46; D&#8217;Agati"
                            2 => "M&#46;M&#46; Schwartz"
                            3 => "S&#46;V&#46; Seshan"
                            4 => "C&#46;E&#46; Alpers"
                            5 => "G&#46;B&#46; Appel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1523-1755.2004.00443.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Kidney Int"
                        "fecha" => "2004"
                        "volumen" => "65"
                        "paginaInicial" => "521"
                        "paginaFinal" => "530"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14717922"
                            "web" => "Medline"
                          ]
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                ]
              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The American College of Rheumatology response criteria for proliferative and membranous renal disease in systemic lupus erythematosus clinical trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;H&#46; Liang"
                            1 => "P&#46;H&#46; Schur"
                            2 => "P&#46; Fortin"
                            3 => "St&#46; Clair"
                            4 => "W&#46; Balow"
                            5 => "J&#46;E&#46;K&#46; Costenbader"
                          ]
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                      ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/art.21625"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Rheum"
                        "fecha" => "2006"
                        "volumen" => "54"
                        "paginaInicial" => "421"
                        "paginaFinal" => "432"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16453282"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hydroxychloroquine use predicts complete renal remission within 12 months among patients treated with mycophenolate mofetil therapy for membranous lupus nephritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "N&#46; Kasitanon"
                            1 => "D&#46;M&#46; Fine"
                            2 => "M&#46; Haas"
                            3 => "L&#46;S&#46; Magder"
                            4 => "M&#46; Petri"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1191/0961203306lu2313oa"
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                        "tituloSerie" => "Lupus"
                        "fecha" => "2006"
                        "volumen" => "15"
                        "paginaInicial" => "366"
                        "paginaFinal" => "370"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16830883"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0230"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sustained remission of lupus nephritis"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46;E&#46;H&#46; Barber"
                            1 => "L&#46; Geldenhuys"
                            2 => "J&#46;G&#46; Hanly"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1191/0961203306lu2271oa"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lupus"
                        "fecha" => "2006"
                        "volumen" => "15"
                        "paginaInicial" => "94"
                        "paginaFinal" => "101"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16539280"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "etiqueta" => "15"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Anti-malarials exert a protective effect while Mestizo patients are at increased risk of developing SLE renal disease&#58; data from a Latin-American cohort"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "G&#46;J&#46; Pons-Estel"
                            1 => "G&#46;S&#46; Alarc&#243;n"
                            2 => "L&#46; Hachuel"
                            3 => "G&#46; Boggio"
                            4 => "D&#46; Wojdyla"
                            5 => "V&#46; Pascual-Ramos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/rheumatology/ker514"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rheumatology"
                        "fecha" => "2012"
                        "volumen" => "51"
                        "paginaInicial" => "1293"
                        "paginaFinal" => "1298"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22389125"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0240"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Identification of clinical and serological factors during induction treatment of lupus nephritis that are associated with renal outcome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Dall&#8217;Era"
                            1 => "V&#46; Levesque"
                            2 => "N&#46; Solomons"
                            3 => "M&#46; Truman"
                            4 => "D&#46; Wofsy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/lupus-2015-000089"
                      "Revista" => array:5 [
                        "tituloSerie" => "Lupus Sci Med"
                        "fecha" => "2015"
                        "volumen" => "2"
                        "paginaInicial" => "e000089"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26023331"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0245"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Protective effect of hydroxychloroquine on renal damage in patients with lupus nephritis&#58; LXV&#44; data from a multiethnic US cohort"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46;J&#46; Pons-Estel"
                            1 => "G&#46;S&#46; Alarc&#243;n"
                            2 => "McGwin Jr&#46;"
                            3 => "M&#46;I&#46; Danila"
                            4 => "J&#46; Zhang"
                            5 => "H&#46;M&#46; Bastian"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/art.24538"
                      "Revista" => array:5 [
                        "tituloSerie" => "Arthritis Care Res"
                        "fecha" => "2009"
                        "volumen" => "61"
                        "paginaInicial" => "830"
                        "paginaFinal" => "839"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "18"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The role of antimalarial agents in the treatment of SLE and lupus nephritis"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46;J&#46; Lee"
                            1 => "E&#46; Silverman"
                            2 => "J&#46;M&#46; Bargman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/nrneph.2011.150"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nat Rev Nephrol"
                        "fecha" => "2011"
                        "volumen" => "7"
                        "paginaInicial" => "718"
                        "paginaFinal" => "729"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22009248"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Previous antimalarial therapy in patients diagnosed with lupus nephritis&#58; Influence on outcomes and survival"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Sis&#243;"
                            1 => "M&#46; Ramos-Casals"
                            2 => "A&#46; Bove"
                            3 => "P&#46; Brito-Zer&#243;n"
                            4 => "N&#46; Soria"
                            5 => "S&#46; Mu&#241;oz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/0961203307086503"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lupus"
                        "fecha" => "2008"
                        "volumen" => "17"
                        "paginaInicial" => "281"
                        "paginaFinal" => "288"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18413408"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical efficacy and side effects of antimalarials in systemic lupus erythematosus&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "G&#46; Ruiz-Irastorza"
                            1 => "M&#46; Ramos-Casals"
                            2 => "P&#46; Brito-Zeron"
                            3 => "M&#46;A&#46; Khamashta"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/ard.2008.101766"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2010"
                        "volumen" => "69"
                        "paginaInicial" => "20"
                        "paginaFinal" => "28"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19103632"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictors of poor renal outcome in patients with lupus nephritis treated with combined pulses of cyclophosphamide and methylprednisolone"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Cort&#233;s-Hern&#225;ndez"
                            1 => "J&#46; Ordi-Ros"
                            2 => "M&#46; Labrador"
                            3 => "A&#46; Segarra"
                            4 => "J&#46;L&#46; Tovar"
                            5 => "E&#46; Balada"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1191/0961203303lu340oa"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lupus"
                        "fecha" => "2003"
                        "volumen" => "12"
                        "paginaInicial" => "287"
                        "paginaFinal" => "296"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12729052"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The significance of arterial hypertension at the onset of clinical lupus nephritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "I&#46;P&#46; Naiker"
                            1 => "V&#46; Chrystal"
                            2 => "I&#46;G&#46;H&#46; Randeree"
                            3 => "Y&#46;K&#46; Seedat"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/pgmj.73.858.230"
                      "Revista" => array:6 [
                        "tituloSerie" => "Postgrad Med J"
                        "fecha" => "1997"
                        "volumen" => "73"
                        "paginaInicial" => "230"
                        "paginaFinal" => "233"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9156126"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "23"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mestizos with systemic lupus erythematosus develop renal disease early while antimalarials retard its appearance&#58; data from a Latin American cohort"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "G&#46;S&#46; Alarc&#243;n"
                            2 => "P&#46;I&#46; Burgos"
                            3 => "L&#46; Hachuel"
                            4 => "G&#46; Boggio"
                            5 => "D&#46; Wojdyla"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
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                        "tituloSerie" => "Lupus"
                        "fecha" => "2013"
                        "volumen" => "22"
                        "paginaInicial" => "899"
                        "paginaFinal" => "907"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23857989"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0280"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prognostic factors in lupus nephritis"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "C&#46;C&#46; Mok"
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1191/0961203305lu2057a"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lupus"
                        "fecha" => "2005"
                        "volumen" => "14"
                        "paginaInicial" => "39"
                        "paginaFinal" => "44"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15732286"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of fluvastatin on expression of p38 mitogen-activated protein kinase in renal tissue of chronic graft versus host disease lupus nephritis in mice"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Q&#46; Zhang"
                            1 => "M&#46; Wang"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Zhonghua Yi Xue Za Zhi"
                        "fecha" => "2014"
                        "volumen" => "94"
                        "paginaInicial" => "1736"
                        "paginaFinal" => "1739"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25151907"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0290"
              "etiqueta" => "26"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Angiotensin inhibition or blockade for the treatment of patients with quiescent lupus nephritis and persistent proteinuria"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "K&#46;C&#46; Tse"
                            1 => "F&#46;K&#46; Li"
                            2 => "S&#46; Tang"
                            3 => "C&#46;S&#46;-O&#46; Tang"
                            4 => "K&#46;N&#46; Lai"
                            5 => "T&#46;M&#46; Chan"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1191/0961203305lu2249oa"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lupus"
                        "fecha" => "2005"
                        "volumen" => "14"
                        "paginaInicial" => "947"
                        "paginaFinal" => "952"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16425574"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antiproteinuric effect of captopril in a patient with lupus nephritis and intractable nephrotic syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "Y&#46; Shapira"
                            1 => "F&#46; Mor"
                            2 => "A&#46; Friedler"
                            3 => "A&#46;J&#46; Wysenbeek"
                            4 => "A&#46; Weinberger"
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                    0 => array:2 [
                      "doi" => "10.1136/ard.49.9.725"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "1990"
                        "volumen" => "49"
                        "paginaInicial" => "725"
                        "paginaFinal" => "727"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2241292"
                            "web" => "Medline"
                          ]
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                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0300"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antiproteinuric effect of angiotensin converting enzyme inhibitors and an angiotensin ii receptor blocker in patients with lupus nephritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
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                            1 => "Y&#46; Matsukawa"
                            2 => "M&#46; Takei"
                            3 => "S&#46; Sawada"
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                        ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/147323000903700335"
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                        "tituloSerie" => "J Int Med Res"
                        "fecha" => "2009"
                        "volumen" => "37"
                        "paginaInicial" => "892"
                        "paginaFinal" => "898"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19589275"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
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                ]
              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Angiotensin-converting enzyme inhibitors delay the occurrence of renal involvement and are associated with a decreased risk of disease activity in patients with systemic lupus erythematosus &#8212; results from LUMINA &#40;LIX&#41;&#58; a multiethnic US cohort"
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                        0 => array:2 [
                          "etal" => false
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                            2 => "L&#46;M&#46; Vil&#225;"
                            3 => "J&#46;D&#46; Reveille"
                            4 => "G&#46;S&#46; Alarc&#243;n"
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                      "titulo" => "The role of aldosterone blockade in murine lupus nephritis"
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                        "volumen" => "10"
                        "paginaInicial" => "R5"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18197980"
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                      "titulo" => "Captopril effect on prostaglandin E2&#44; thromboxane B2 and proteinuria in lupus nephritis patients"
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                        0 => array:2 [
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                        "paginaInicial" => "194"
                        "paginaFinal" => "201"
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                      "titulo" => "inhibitor reduces Th2 cytokines and TGF-&#946;1 and TGF-&#946;2 isoforms in murine lupus nephritis"
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                        "paginaInicial" => "846"
                        "paginaFinal" => "859"
                        "link" => array:1 [
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Article information

ISSN: 01218123
Original language: English

DOI:10.1016/j.rcreu.2021.03.010

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