title: Intravenous cyclophosphamide combined with steroids in pediatric onset severe lupus nephritis.
abstract: BACKGROUND
  Intravenous cyclophosphamide (IVCY) has been used to treat severe lupus nephritis (LN) for many years. Because of the wide variety of manifestations of the condition and the long-term nature of the disease, outcomes vary widely.
  
  
  OBJECTIVE
  To evaluate and compare the immediate and long-term results of IVCY in pediatric onset severe LN and between patients with normal and abnormal initial renal function.
  
  
  METHODS
  Patients aged <18 years who attended the Department of Pediatrics, Prince of Songkla University, diagnosed with severe LN, and who were given a 36-month IVCY course, were included. Comparison of overall survival between the two groups was assessed using Kaplan-Meier survival curves.
  
  
  RESULTS
  108 patients with a mean age of 12.6 ± 2.7 years were studied, with a mean follow-up time of 5.7 ± 4.3 years. 48 patients completed the IVCY course. 36 patients had abnormal renal function and 72 patients had normal renal function at the start of therapy. Both groups responded well initially to treatment; proteinuria reduced to normal levels after 1 and 2 treatments in the normal and abnormal groups, respectively, while creatinine clearance returned to normal levels after 8 treatments in the abnormal group. Overall survival was not different between the two groups; however, the abnormal renal function group had a higher crude mortality rate than the normal group (13/36 vs 10/72, p value = 0.02). At the time of analysis, some patients who had completed their IVCY course still required other therapy to control their disease activity.
  
  
  CONCLUSIONS
  Three years of IVCY treatment provided similar outcomes in both normal and abnormal renal function groups. Immediate outcomes were favorable but long-term remission was not promising.
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, 90110, Songkla, Thailand, vprayong@gmail.com.
authors.forename: Prayong
authors.initials: P
authors.lastname: Vachvanichsanong
authors.forename: Pornsak
authors.initials: P
authors.lastname: Dissaneewate
authors.forename: Edward
authors.initials: E
authors.lastname: McNeil
mesh_terms: D061605:Administration, Intravenous; D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood / Q000652:urine; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008181:Lupus Nephritis / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D011239:Prednisolone / Q000627:therapeutic use*; D011507:Proteinuria / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D011239:Prednisolone; D003404:Creatinine; D008775:Methylprednisolone