title: [Mycophenolate mofetil in induction and maintenance therapy for juvenile onset severe lupus nephritis].
abstract: OBJECTIVE
  The aim of the present study was to evaluate the efficacy of mycophenolate mofetil (MMF) in the induction and maintenance therapy for juvenile onset severe lupus nephritis.
  
  
  METHODS
  Children with severe focal, and diffuse proliferative lupus nephritis were treated with prednisolone (initial dose; 1 mg/kg/day, maximum dose; 60 mg/day) and MMF (initial dose; 300 mg/m2/day, increased to 1 g/m2/day) for 24 months after high-dose intravenous methylprednisolone (30 mg/kg/day). Urinalysis was performed, and renal function, and albumin were evaluated. Serum anti-double-stranded DNA antibody, and also serum C3 and C4 were measured. The duration of induction therapy was defined as the initial 6 months after treatment. The duration of maintenance therapy was defined as 18 months after induction therapy.
  
  
  RESULTS
  Twelve children (mean age 12.6 +/- 1.7 years)were treated with induction therapy. With 6 months of induction therapy, urine protein, and serum anti-double-stranded DNA antibody, decreased significantly (p < 0.05), renal function improved, and albumin, serum C3 and C4 increased significantly (p < 0.05). Ten children received maintenance therapy. No patients had renal flares during maintenance therapy. The mean prednisolone dose was tapered to 9.2 +/- 2.3 mg/day. Among 5 patients who had a second biopsy after MMF therapy, 4 showed a significant reduction and one had no change in histology. Major infection episodes occurred in 5 patients: Herpes zoster in 3 patients, bacteremia in 2, and hair loss in 3, respectively. No patients discontinued MMF therapy.
  
  
  CONCLUSIONS
  MMF is an effective induction and maintenance therapy for juvenile onset severe lupus nephritis.
authors.affiliation: Department of Pediatric Nephrology, Prefectural Okinawa Nanbu Medical Center and Children's Medical Center, Japan.
authors.forename: Tomoo
authors.initials: T
authors.lastname: Kise
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yoshimura
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy; D008181:Lupus Nephritis / Q000188:drug therapy*; D060046:Maintenance Chemotherapy; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D011239:Prednisolone / Q000008:administration & dosage; D020551:Pulse Therapy, Drug; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D011239:Prednisolone; D009173:Mycophenolic Acid; D008775:Methylprednisolone