Document Detail


The efficacy of intravenous pulse cyclophosphamide in the treatment of severe lupus nephritis in children.
MedLine Citation:
PMID:  10730528     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The intermittent intravenous cyclophosphamide in the treatment of lupus nephritis in adults is well tolerated and associated with clinical improvement and long term stability of renal function. However, there are few reports about the efficacy of intravenous pulse cyclophosphamide (IPC) of severe lupus nephritis in children. OBJECTIVE: To evaluate the clinical efficacy, renal function, renal outcome and complications of IPC therapy in children with severe lupus nephritis. METHOD: Prospective study. PATIENTS: Children with severe lupus nephritis have been followed-up for at least 6 months. Treatment regimen: Intravenous pulse cyclophosphamide 0.5-0.75 g/m2 given monthly for 6 months with subsequent doses given at 2-3 months interval up to 3 years and combined with low dose oral prednisolone therapy. RESULTS: Thirty-one children (mean age: 12.31 +/- 2.03 years; female:male = 24:7) with severe lupus nephritis received IPC therapy. 24 out of 28 patients (85.7%) had diffuse proliferative glomerulonephritis. After 3 months of treatment, most patients were clinically improved as evidenced by significant improvements in 24-hour urine protein, creatinine clearance, serum creatinine, BUN, serum albumin and C3 level. These improvements were sustained up to 18 months and were accompanied by a significant reduction in prednisolone dosage. Renal outcome at the last follow-up (range = 6-76 months) demonstrated that twelve patients (38.7%) had complete remission, 18 patients (58.0%) still had significant proteinuria and only one had serum creatinine of 1.6 mg/dl at 42 months. One child progressed to end stage renal diseases during IPC therapy. Five patients had severe infections during the treatment resulting in one death. Hemorrhagic cystitis and malignancies were not found. CONCLUSION: Treatment of severe lupus nephritis in children with intravenous pulse cyclophosphamide is associated with favorable short term results. Severe infections are the major complications.
Authors:
K Tangnararatchakit; C Tapaneya-Olarn; W Tapaneya-Olarn
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the Medical Association of Thailand = Chotmaihet thangphaet     Volume:  82 Suppl 1     ISSN:  0125-2208     ISO Abbreviation:  J Med Assoc Thai     Publication Date:  1999 Nov 
Date Detail:
Created Date:  2000-04-05     Completed Date:  2000-04-05     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7507216     Medline TA:  J Med Assoc Thai     Country:  THAILAND    
Other Details:
Languages:  eng     Pagination:  S104-10     Citation Subset:  IM    
Affiliation:
Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Anti-Inflammatory Agents / therapeutic use
Child
Cyclophosphamide / administration & dosage,  therapeutic use*
Female
Humans
Immunosuppressive Agents / administration & dosage,  therapeutic use*
Lupus Nephritis / drug therapy*
Male
Prednisolone / therapeutic use
Prospective Studies
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anti-Inflammatory Agents; 0/Immunosuppressive Agents; 50-18-0/Cyclophosphamide; 50-24-8/Prednisolone

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