Effect of low-dose cyclosporine A in the treatment of refractory proteinuria in childhood-onset lupus nephritis
Por:
Baca V., Catalán T., Villasís-Keever M., Ramón G., Morales A.M., Rodríguez-Leyva F.
Publicada:
1 ene 2006
Resumen:
We performed a prospective study to evaluate the efficacy and safety of low-dose cyclosporine A (CSA) treatment in paediatric lupus nephritis refractory to conventional therapy. Seven children with biopsy-proven Class III-IV lupus nephritis were treated with CSA (2-4mg/kg/day) combined with low-dose prednisone for one year. All patients had failed to achieve sustained proteinuria remission with corticosteroids and cytotoxic drugs. Proteinuria decreased from median value of 2.5 g/24 hours (range, 1.2-4.9) to 0.14 g/24 hours (range, 0.0-0.84) after treatment (P = 0.018). Median values of creatinine clearance and serum creatinine did not change significantly. Median systemic lupus erythematosus disease activity index score decreased from 12 (range, 6-16) to 4 (range, 0-8) at end of treatment (P = 0.027). However, two patients experienced flares of extrarrenal manifestations and complement levels did not improve. Moreover, most patients relapsed with proteinuria within a few months of stopping CSA therapy. Side effects were not significant. In conclusion, low-dose of CSA combined with steroids appears to be useful to reduce proteinuria in paediatric proliferative lupus nephritis refractory to steroids and cytotoxic drugs; however, relapses are common after CSA discontinuation. Further studies are needed to define the precise role of CSA in paediatric lupus nephritis. © 2006 SAGE Publications.
Filiaciones:
Baca V.:
Department of Rheumatology, Hospital de Pediatría, Instituto Mexicano del Seguro Social (IMSS), México, D.F., Mexico
Departamento de Reumatología, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Av. Cuauhtémoc No. 330, C.P. 06720, México D.F., Mexico
Catalán T.:
Department of Rheumatology, Hospital de Pediatría, Instituto Mexicano del Seguro Social (IMSS), México, D.F., Mexico
Villasís-Keever M.:
Clinical Epidemiology Research Unit, Hospital de Pediatría, Instituto Mexicano del Seguro Social (IMSS), México, D.F., Mexico
Ramón G.:
Department of Pathology, Hospital de Pediatría, Instituto Mexicano del Seguro Social (IMSS), México, D.F., Mexico
Morales A.M.:
Department of Nephrology, Hospital de Pediatría, Instituto Mexicano del Seguro Social (IMSS), México, D.F., Mexico
Rodríguez-Leyva F.:
Department of Nephrology, Hospital de Pediatría, Instituto Mexicano del Seguro Social (IMSS), México, D.F., Mexico
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