Outcomes of children with proliferative lupus nephritis: the role of protocol renal biopsy
| Autor: | Ankur A Kamdar, Barry L. Myones, Arundhati S. Kale, Marietta De Guzman, M. John Hicks, Robert W. Warren, Anna Minta, María Honrubia Pérez, David J. Askenazi |
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| Rok vydání: | 2007 |
| Předmět: |
Male
Nephrology medicine.medical_specialty Pathology Time Factors Neutrophils Biopsy Lupus nephritis Renal function Kidney Gastroenterology Drug Administration Schedule Leukocyte Count Internal medicine medicine Humans Lupus Erythematosus Systemic Kidney surgery Child Cyclophosphamide Retrospective Studies Lupus erythematosus medicine.diagnostic_test business.industry medicine.disease Lupus Nephritis Treatment Outcome Pulse Therapy Drug Injections Intravenous Pediatrics Perinatology and Child Health Absolute neutrophil count Female Renal biopsy business Immunosuppressive Agents Follow-Up Studies |
| Zdroj: | Pediatric Nephrology. 22:981-986 |
| ISSN: | 1432-198X 0931-041X |
| DOI: | 10.1007/s00467-007-0447-9 |
| Popis: | Outcomes in children with proliferate lupus nephritis (PLN) show 9-15% progress to end-stage renal disease (ESRD) at 5 years. Immunosuppression improves outcome, but significant side effects are possible. Clinical and laboratory analyses are poor predictors of class and progression in PLN. We describe 28 patients with systemic lupus erythematosus (SLE), between 1990 and 2005, whose initial biopsy (Bx1) showed PLN and who received nine monthly doses of intravenously administered cyclophosphamide (CYP) (500-750 mg/m(2) up to 1 g to maintain their absolute neutrophil count (ANC) > 3,000). Continued therapy with additional quarterly intravenous (i.v). administration of CYP was dictated by repeat renal biopsy (Bx2). Bx1 was done 1 +/- 1.6 years after diagnosis of SLE. Bx2 showed histological improvement by WHO classification in 20/25 children; 3/25 were unchanged, 1/25 was categorized as new class V, and 1/25 was worse. Four patients (14%) had infectious complications requiring hospitalization (one of these died). Mean follow-up (f/u) after Bx2 was 3.5 +/- 2.3 years. At last follow-up, 26 patients had normal glomerular filtration rate (GFR), with a mean of 126 +/- 42.8 ml/min per 1.73 m(2) body surface area, one non-compliant patient had ESRD, and one had chronic renal failure. At last follow-up, most patients had minimal to no proteinuria. Clinical and biopsy results greatly improved after 9 monthly intravenously administered CYP pulses in most children with class IV PLN. Those who did not improve are at risk for flares and progression of disease. The tailoring of therapies based on findings from a biopsy after induction may improve outcomes. |
| Databáze: | OpenAIRE |
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