New treatment strategies for proliferative lupus nephritis: keep children in mind!
Renal involvement is frequent in children with systemic lupus erythematosus (SLE) and carries significant short and long-term morbidity. Treatment strategy in proliferative glomerulonephritis relies mainly on studies in adult patients where conventional treatment regimens including high doses of cyclophosphamide (CYC) and steroids may cause severe side effects. New strategies including sequential therapies of various combinations of low dose CYC, calcineurine inhibitors (cyclosporine or tacrolimus), mycophenolate mofetil, azathioprine, rituximab are now under investigation in adult patients with very few data in children. Organization of international registries and controlled trials in children with lupus nephritis is mandatory to determine long term prognosis and to validate less toxic therapy regimens in childhood.
Ranchin
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B
Paediatric Nephrology Unit, Centre de Référence des Maladies Rénales Héréditaires, Hospices Civils de Lyon and Université Lyon 1, Lyon, France. bruno.ranchin@chu-lyon.fr
Fargue
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S
D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D001379:Azathioprine / Q000627:therapeutic use; D065095:Calcineurin Inhibitors; D002648:Child; D003520:Cyclophosphamide / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008181:Lupus Nephritis / Q000188:drug therapy* / Q000503:physiopathology; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010372:Pediatrics; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D000069283:Rituximab
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D000069283:Rituximab; D003520:Cyclophosphamide; D009173:Mycophenolic Acid; D001379:Azathioprine