Paper Information

Journal:   INTERNATIONAL JOURNAL OF PREVENTIVE MEDICINE   2014 , Volume 5 , Number 3; Page(s) 250 To 255.
 
Paper: 

A TREATMENT ALGORITHM FOR CHILDREN WITH LUPUS NEPHRITIS TO PREVENT DEVELOPING RENAL FAILURE

 
 
Author(s):  HAJIZADEH NILOOFAR, JAVADI LAIJANI FAEZEH, MOGHTADERI MASTANEH, ATAEI NEAMATOLLAH, ASADI FARAHNAK*
 
* 445 E. NORTH WATER STREET, SUITE 1804, CHICAGO, IL
 
Abstract: 

Chronic kidney disease is one of the most common complication of systemic lupus erythematous, which if untreated can lead to the end-stage renal disease (ESRD). Early diagnosis and adequate treatment of lupus nephritis (LN) is critical to prevent the chronic kidney disease incidence and to reduce the development of ESRD. The treatment of LN has changed significantly over the past decade. In patients with active proliferative LN (Classes III and IV) intravenous methylprednisolone 1 g/m2 /day for 1-3 days then prednisone 0.5-1.0 mg/kg/day, tapered to <0.5 mg/kg/day after 10-12 weeks of treatment plus mycophenolate mofetile (MMF) 1.2 g/m2 /day for 6 months followed by maintenance lower doses of MMF 1-2 g/day or azathioprine (AZA) 2 mg/kg/day for 3 years have proven to be efficacy and less toxic than cyclophosphamide (CYC) therapy. Patients with membranous LN (Class V) plus diffuse or local proliferative LN (Class III and Class IV) should receive either the standard 6 monthly pulses of CYC (0.5-1 g/m2 /month) then every 3 rd month or to a shorter treatment course consisting of 0.5 g/m2 IV CYC every 2 weeks for six doses (total dose 3 g) followed by maintenance therapy with daily AZA (2 mg/kg/day) or MMF (0.6 g/m2 /day) for 3 years. Combination of MMF plus rituximab or MMF plus calcineurin inhibitors may be an effective co-therapy for those refractory to induction or maintenance therapies. This report introduces a new treatment algorithm to prevent the development of ESRD in children with LN.

 
Keyword(s): END-STAGE RENAL DISEASE, LUPUS, NEPHRITIS, TREATMENT ALGORITHM
 
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