An Update on Treatment and Outcome of Lupus Nephritis in Children

Demircin, Gülay

doi:10.5455/apr.081820131500

Cited by 1 publication

(1 citation statement)

References 47 publications

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“…An ideal therapy for LN would be non-toxic, easy to administer, affordable, would achieve early complete remission, would not require prolonged use, would prevent relapse and essentially cure the disease instead of controlling it. Newer therapeutic options are being explored [ 5 , 28 , 29 ]. Our hospital uses a modified protocol of IVC, discussed before, that is based on local experience, considers the relatively smaller body surface area of our patients and aims to decrease the gonadal toxicity of IVC in young females.…”

Section: Discussionmentioning

confidence: 99%

Outcome of low dose cyclophosphamide for induction phase treatment of lupus nephritis, a single center study

2016

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BackgroundThe current standard for induction phase treatment of lupus nephritis is steroid combined with mycophenolate mofetil or pulse intravenous cyclophosphamide (IVC). The lowest dose of IVC recommended for induction therapy is that used in the Euro-Lupus Trial. It is not known whether same cumulative dose of IVC would be effective when given over six months.MethodsWe carried out a prospective, observational study on 41 patients of biopsy-proven lupus nephritis (class III, IV, V or mixed). For induction, patients received six pulses of monthly IVC (500 mg each), along with steroid. Patients were followed up monthly until one month beyond completion of the sixth pulse. The outcomes assessed were complete remission (proteinuria < 200 mg/day or urine albumin nil with serum albumin >35 gm/L, stable estimated glomerular filtration rate (eGFR) if normal at baseline or increase in eGFR by 25 % if abnormal at baseline and normal urinary sediment), response (complete or partial remissions), complications of therapy and death.ResultsTwenty two patients (53.7 %) had class IV nephritis. Eighteen patients (43.9 %) achieved complete remission, 16 (39.0 %) achieved partial remission, yielding an overall response rate of 82.9 %. Nephrotic range proteinuria (UTP ≥ 3 g/day) and severe hypoalbuminemia (serum albumin < 20 g/L) at baseline influenced remission (p <0.05). Infection, seen in 12 patients (29.3 %), was the most common complication. Four deaths (9.6 %) were observed, all due to infection.ConclusionsFor induction phase treatment, Nepalese patients with lupus nephritis responded favorably to steroid and low dose IVC of 3 grams given as six monthly pulses.

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Section: Discussionmentioning

confidence: 99%