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Intravenous cyclophosphamide combined with steroids in pediatric onset severe lupus nephritis.

Vachvanichsanong P, Dissaneewate P, McNeil E - Int Urol Nephrol (2012)

Bottom Line: Both groups responded well initially to treatment; proteinuria reduced to normal levels after 1 and 2 treatments in the normal and abnormal groups, respectively, while creatinine clearance returned to normal levels after 8 treatments in the abnormal group.At the time of analysis, some patients who had completed their IVCY course still required other therapy to control their disease activity.Immediate outcomes were favorable but long-term remission was not promising.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, 90110, Songkla, Thailand, vprayong@gmail.com.

ABSTRACT

Background: Intravenous cyclophosphamide (IVCY) has been used to treat severe lupus nephritis (LN) for many years. Because of the wide variety of manifestations of the condition and the long-term nature of the disease, outcomes vary widely.

Objective: To evaluate and compare the immediate and long-term results of IVCY in pediatric onset severe LN and between patients with normal and abnormal initial renal function.

Methods: Patients aged <18 years who attended the Department of Pediatrics, Prince of Songkla University, diagnosed with severe LN, and who were given a 36-month IVCY course, were included. Comparison of overall survival between the two groups was assessed using Kaplan-Meier survival curves.

Results: 108 patients with a mean age of 12.6 ± 2.7 years were studied, with a mean follow-up time of 5.7 ± 4.3 years. 48 patients completed the IVCY course. 36 patients had abnormal renal function and 72 patients had normal renal function at the start of therapy. Both groups responded well initially to treatment; proteinuria reduced to normal levels after 1 and 2 treatments in the normal and abnormal groups, respectively, while creatinine clearance returned to normal levels after 8 treatments in the abnormal group. Overall survival was not different between the two groups; however, the abnormal renal function group had a higher crude mortality rate than the normal group (13/36 vs 10/72, p value = 0.02). At the time of analysis, some patients who had completed their IVCY course still required other therapy to control their disease activity.

Conclusion: Three years of IVCY treatment provided similar outcomes in both normal and abnormal renal function groups. Immediate outcomes were favorable but long-term remission was not promising.

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Related in: MedlinePlus

Comparison of serum creatinine, creatinine clearance, urinary protein, hemoglobin, white blood cell count, platelet count, C3, and antinuclear antibody over the 17-treatment course of IVCY between patients with abnormal renal function (black) and normal renal function (gray) (N = 36 vs 72)
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Fig1: Comparison of serum creatinine, creatinine clearance, urinary protein, hemoglobin, white blood cell count, platelet count, C3, and antinuclear antibody over the 17-treatment course of IVCY between patients with abnormal renal function (black) and normal renal function (gray) (N = 36 vs 72)

Mentions: Figure 1 shows the comparison of laboratory findings of the two groups of patients during IVCY therapy. Serum creatinine and creatinine clearance were not changed during the period of therapy for patients with normal renal function. For patients with abnormal renal function, the creatinine level and creatinine clearance gradually improved and reached normal levels after the 8th treatment; however, only 20 of these patients completed the full course of 17 treatments. Proteinuria dramatically decreased after 1 treatment of IVCY in patients who had normal renal function, while urinary protein decreased after 2 treatments of IVCY in patients who had abnormal renal function.Fig. 1


Intravenous cyclophosphamide combined with steroids in pediatric onset severe lupus nephritis.

Vachvanichsanong P, Dissaneewate P, McNeil E - Int Urol Nephrol (2012)

Comparison of serum creatinine, creatinine clearance, urinary protein, hemoglobin, white blood cell count, platelet count, C3, and antinuclear antibody over the 17-treatment course of IVCY between patients with abnormal renal function (black) and normal renal function (gray) (N = 36 vs 72)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3824347&req=5

Fig1: Comparison of serum creatinine, creatinine clearance, urinary protein, hemoglobin, white blood cell count, platelet count, C3, and antinuclear antibody over the 17-treatment course of IVCY between patients with abnormal renal function (black) and normal renal function (gray) (N = 36 vs 72)
Mentions: Figure 1 shows the comparison of laboratory findings of the two groups of patients during IVCY therapy. Serum creatinine and creatinine clearance were not changed during the period of therapy for patients with normal renal function. For patients with abnormal renal function, the creatinine level and creatinine clearance gradually improved and reached normal levels after the 8th treatment; however, only 20 of these patients completed the full course of 17 treatments. Proteinuria dramatically decreased after 1 treatment of IVCY in patients who had normal renal function, while urinary protein decreased after 2 treatments of IVCY in patients who had abnormal renal function.Fig. 1

Bottom Line: Both groups responded well initially to treatment; proteinuria reduced to normal levels after 1 and 2 treatments in the normal and abnormal groups, respectively, while creatinine clearance returned to normal levels after 8 treatments in the abnormal group.At the time of analysis, some patients who had completed their IVCY course still required other therapy to control their disease activity.Immediate outcomes were favorable but long-term remission was not promising.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, 90110, Songkla, Thailand, vprayong@gmail.com.

ABSTRACT

Background: Intravenous cyclophosphamide (IVCY) has been used to treat severe lupus nephritis (LN) for many years. Because of the wide variety of manifestations of the condition and the long-term nature of the disease, outcomes vary widely.

Objective: To evaluate and compare the immediate and long-term results of IVCY in pediatric onset severe LN and between patients with normal and abnormal initial renal function.

Methods: Patients aged <18 years who attended the Department of Pediatrics, Prince of Songkla University, diagnosed with severe LN, and who were given a 36-month IVCY course, were included. Comparison of overall survival between the two groups was assessed using Kaplan-Meier survival curves.

Results: 108 patients with a mean age of 12.6 ± 2.7 years were studied, with a mean follow-up time of 5.7 ± 4.3 years. 48 patients completed the IVCY course. 36 patients had abnormal renal function and 72 patients had normal renal function at the start of therapy. Both groups responded well initially to treatment; proteinuria reduced to normal levels after 1 and 2 treatments in the normal and abnormal groups, respectively, while creatinine clearance returned to normal levels after 8 treatments in the abnormal group. Overall survival was not different between the two groups; however, the abnormal renal function group had a higher crude mortality rate than the normal group (13/36 vs 10/72, p value = 0.02). At the time of analysis, some patients who had completed their IVCY course still required other therapy to control their disease activity.

Conclusion: Three years of IVCY treatment provided similar outcomes in both normal and abnormal renal function groups. Immediate outcomes were favorable but long-term remission was not promising.

Show MeSH
Related in: MedlinePlus