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Intravenous cyclophosphamide combined with steroids in pediatric onset severe lupus nephritis

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-t...

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Autores principales: Vachvanichsanong, Prayong, Dissaneewate, Pornsak, McNeil, Edward
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Netherlands 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3824347/
https://www.ncbi.nlm.nih.gov/pubmed/23225077
http://dx.doi.org/10.1007/s11255-012-0331-9
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author Vachvanichsanong, Prayong
Dissaneewate, Pornsak
McNeil, Edward
author_facet Vachvanichsanong, Prayong
Dissaneewate, Pornsak
McNeil, Edward
author_sort Vachvanichsanong, Prayong
collection PubMed
description 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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spelling pubmed-38243472013-11-21 Intravenous cyclophosphamide combined with steroids in pediatric onset severe lupus nephritis Vachvanichsanong, Prayong Dissaneewate, Pornsak McNeil, Edward Int Urol Nephrol Nephrology - Original Paper 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. Springer Netherlands 2012-12-07 2013 /pmc/articles/PMC3824347/ /pubmed/23225077 http://dx.doi.org/10.1007/s11255-012-0331-9 Text en © The Author(s) 2012 https://creativecommons.org/licenses/by/2.0/ Open AccessThis article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.
spellingShingle Nephrology - Original Paper
Vachvanichsanong, Prayong
Dissaneewate, Pornsak
McNeil, Edward
Intravenous cyclophosphamide combined with steroids in pediatric onset severe lupus nephritis
title Intravenous cyclophosphamide combined with steroids in pediatric onset severe lupus nephritis
title_full Intravenous cyclophosphamide combined with steroids in pediatric onset severe lupus nephritis
title_fullStr Intravenous cyclophosphamide combined with steroids in pediatric onset severe lupus nephritis
title_full_unstemmed Intravenous cyclophosphamide combined with steroids in pediatric onset severe lupus nephritis
title_short Intravenous cyclophosphamide combined with steroids in pediatric onset severe lupus nephritis
title_sort intravenous cyclophosphamide combined with steroids in pediatric onset severe lupus nephritis
topic Nephrology - Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3824347/
https://www.ncbi.nlm.nih.gov/pubmed/23225077
http://dx.doi.org/10.1007/s11255-012-0331-9
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