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Original ArticleOpen Access
The Efficacy of Intravenous Pulse Cyclophosphamide in the Treatment of Severe Lupus Nephritis in Children
Tangnararatchakit K 
,
Tapaneya0arn C ,
Tapaneya0arn W
,
Tapaneya0arn C ,
Tapaneya0arn W 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 gfm2 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.
Key word : Lupus Nephritis, Children, Pulse Cyclophosphamide, Treatment
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 gfm2 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.
Key word : Lupus Nephritis, Children, Pulse Cyclophosphamide, Treatment
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