الفهرس 
LUPUS NEPHRITIS (LN)Only 14 pages are availabe for public view
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Abstract
hildhood-onset systemic lupus erythematosus (cSLE) is a rare but severe autoimmune disease with multisystem involvement and the kidneys are one of the major organs that are involved in SLE and different types of renal disorders appear.
According to the pathological changes in the kidney, lupus nephritis can be either proliferative (class III or IV) or non-proliferative glomerulonephritis (class II or V).The proliferative forms are more dangerous and may progress to end-stage renal failure over weeks to years. Steroid therapy has been used as the first-line treatment, and over the years many immunosuppressive drugs, including pulse methylprednisolone, oral cyclophosphamide, pulse intravenous cyclophosphamide, mycophenolate mofetil and rituximab have been combined with prednisolone, further improving renal survival rates.
Immunosuppressive therapy for proliferative LN consists of induction and maintenance phases: induction therapy involves the administration of agents to achieve remission of immunologic disease. Once remission is achieved, maintenance therapy is given for a prolonged period to help prevent relapse. Maintenance therapy is also aimed at preventing non-immunologic progression of the renal disease.
Our study aimed to compare the efficacy and tolerability of mycophenolate mofetil versus cyclophosphamide as immunosuppressive therapy in induction and maintenance of remission of proliferative lupus nephritis in pediatric patients.
Our study included 25 patient with lupus nephritis and received cyclophosphamide and/or mycophenolate mofetil as induction of remission or maintenance therapy.
Patients’ data gathered from their medical records in the Pediatric Allergy and Immunology Unit, Children’s Hospital, Ain-Shams University.
The 25 patients enrolled, included 4 male patients representing (16%) of all the patients and 21 females representing (84%). Female to male ratio was 5:1.
Their age ranged from 8-18 year, The age at diagnosis ranged from 4.5-14 years and the duration of the lupus nephritis ranged from 1to 8 years.
We divided the patients into two groups according to the treatment; group A included patients who received cyclophosphamide, group B included patients who received mycophenolate mofetil.
As regards renal function tests in the term of serum creatinine and serum urea and creatinine clearance, both cyclophosphamide and mycophenolate mofetil showed improvement of the renal function.
cyclophosphamide showed better control with significant improvement in total SLEDAI score, Anti-dsDNA, which decreased by 73% with cyclophosphamide therapy but increased with mycophenolate mofetil by 23%.
The effect of the therapy on renal disease activity showed large difference between cyclophosphamideand mycophenolate mofetil. Cyclophosphamide therapy improved proteinuria by 60% in comparison to increase in 24 hour protein by 136% with mycophenolate mofetil therapy. But renal SLEDAI and BILAG scores showed improvement in both groups; Yet, cyclophosphamide therapy showed more prominent improvement.
Renal SLEDAI decreased by 37% with mycophenolate mofetil therapy in comparison to 81% decrease with cyclophosphamide therapy. As regards renal BILAG score, 70% of the cases showed remission with cyclophosphamide therapy compared to 44% with mycophenolate mofetil, Also 16% showed relapse in renal BILAG with mycophenolate mofetil and none with cyclophosphamide therapy.
As regards complication and tolerability, mycophenolate mofetil was found to be more tolerable with less incidence of infections.
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