Evaluation the effectiveness of intravenous cyclophosphamide treatment in children with lupus nephritis

Abstract

Objective: Renal involvement in systemic lupus erythematosus is an important cause of morbidity and mortality. Cyclophosphamide is widely used in the treatment of lupus nephritis. The aim of this study is to evaluate the effectiveness of intravenous cyclophosphamide treatment in children with lupus nephritis. Material and Method: In this study, 28 patients with lupus nephritis treated by intravenous pulse cyclophosphamide between the years 1999, and 2011 in Istanbul Faculty of Medicine, Department of Pediatric Nephrology were investigated retrospectively. Clinical history, presenting symptoms and findings, laboratory analysis, results of renal biopsy, treatment methods and prognosis were evaluated. Results: Proteinuria was determined in 27 (96.5%), macroscopic hematuria in 4 (14.3%), hypertension in 15 (53.5%), and renal failure in 11 patients (39.2%) as initial presentations. The most frequent extrarenal clinical findings were arthritis/arthralgia (67.9%), constitutional (64.3%) and skin findings (60.7%). The most frequent histopathological finding of lupus nephritis patients in our study group was Class 4 lupus nephritis (53.5%), followed by Class 2 (21,6%), Class 3 (10,7%) and Class 5 (3.5%) nephritis respectively. Renal remission was obtained in 21 (75%) patients throughout 62.7±49 (6-204) months of follow up period in study group. Nineteen patients (67.8%) were in remission in terms of both renal and extrarenal findings. Morbidity ratio (ESRF) was 14.2%, and mortality rate was 3.5% in our study group. ESRF and death in the study group were statistically related to increased serum creatinine levels during the initial presentation (p: 0.047). Side effects of intravenous cyclophosphamide were detected in 39.2% of the patients, while most frequent side effect was neutropenia (21.4%). Conclusion: In this study, intravenous cyclophosphamide treatment was determined as effective and reliable with minimum side effects in order to obtain renal and extrarenal remission in patients with pediatric lupus nephritis. The presence of high serum creatinine during the initial presentation was found as a poor prognostic factor.