Lupus Nephritis in Pediatric Patients 1642

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This preliminary study was undertaken to retrospectively analyze our institution's experience on the course, outcome, and effects of treatment of pediatric Lupus Nephritis(LN). The charts of 32 patients out of a total of 72 patients with Systemic Lupus Erythematosis (SLE) between the years 1978 and 1996 were reviewed. Renal biopsies were performed on 22 patients. Eight patients had type 4, and 5 had type 5 nephritis. All patients received variable doses of prednisone depending on their state of disease activity. 11 patients received IV Cyclophosphamide (CYA) at 1,2, and 5months after initial diagnosis. Two patients had their course of IV CYA repeated following deterioration of their renal status. Both patients progressed to ESRD in 2.5± 1.0 years. Two patients with Type 4 nephritis were treated with a combination of oral Prednisone, Imuran and CYA (triple therapy) in low doses. One patient maintained stable renal status for a followup period of 5 years. The other patient had recurrence of protienuria 2 years after the initial diagnosis. However his biopsy did not show any progression of renal disease and his proteinuria resolved following a bolus of methylprednisolone. In conclusion, patients with type 4 nephritis had the worst prognosis even when the initial biopsy showed little evidence of chronicity. Treatment with IV CYA delayed progression of renal disease but did not prevent it. Although only two patients received low dose oral triple therapy, it is possible that this regimen may ameliorate and prevent progression of renal disease.Table

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(Spon by: Jose Strauss,M.D)

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