Crossroads of the effects of cyclophosphamide pulse therapy for lupus nephritis--experience of 11 cases.
In this study time for initial assessment of monthly intravenous cyclophosphamide (CP) pulse therapy is discussed for a better outcome with less complications. Eleven patients with lupus nephritis (LN) resistant to conventional therapy (serum creatinine level < or = 2.7 mg/dl) were given 500 mg/m2 of CP 7-9 times with an interval of one month. Urinary protein (Up) decreased in all patients after 3 courses of CP pulse therapy and kept similar levels thereafter. In one group of patients (n = 7), Up decreased to < 2 g/day after 3 courses, while in the other group (n = 4), it did not decrease to < 4 g/day. Creatinine clearance increased by 0-100% in the former group, while it decreased by 5-20% in the latter group after 6-9 courses. Renal function of the patients with insufficient response after 3 courses tended to show no further improvement or worsened thereafter, although Up decreased during CP pulse therapy. A relatively small dose of CP (500 mg/m2) pulse therapy was useful in most LN patients regardless of the renal histology and it was thought important to assess its effects after 3 courses for a prediction of the clinical course. Modification of the protocol at that time might be necessary in regard to dose or interval of CP administration especially for patients with insufficient outcome.
Funauchi
M
M
Third Department of Internal Medicine, Kinki University, School of Medicine, Osaka, Japan.
Ikoma
S
S
Sugiyama
M
M
Yu
H
H
Ohno
M
M
Kinoshita
K
K
Hamada
K
K
Kanamaru
A
A
D000328:Adult; D000974:Antibodies, Antinuclear / Q000097:blood; D003404:Creatinine / Q000652:urine; D003520:Cyclophosphamide / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008180:Lupus Erythematosus, Systemic / Q000097:blood / Q000188:drug therapy / Q000652:urine; D008181:Lupus Nephritis / Q000097:blood / Q000188:drug therapy* / Q000652:urine; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000209:etiology; D012709:Serum Albumin / Q000378:metabolism
D000974:Antibodies, Antinuclear; D012709:Serum Albumin; D003520:Cyclophosphamide; D003404:Creatinine