Immunosuppressive Therapy of Pediatric Lupus Nephritis

Abstract

Lupus nephritis is a disease caused by severe complications of Systemic Lupus Erythematosus which attacks the kidneys. Therapy that is usually given to lupus nephritis patients is immunosuppressants. To determine the pattern of immunosuppressive therapy in pediatric lupus nephritis, the effectiveness and drug interactions that can be generated from these therapies. This study was an observational study with a retrospective method by observing patients’ medical record. This study populations were all pediatric patients ≤18 years old who were diagnosed with late onset of lupus nephritis, being hospitalized at Surabaya Hospital and had an immunosuppressive therapy history. There were 30 patients who met the inclusion criteria in this study. The sample collecting used a purposive sampling technique. The research instrument in this study was the medical record of department of pediatric in hospital of east Indonesia, Namely Dr. Soetomo. From the medical record data, we obtained information regarding the pattern of immunosuppressants administration including dosage, route, frequency of therapy, drug side effects, and drug interactions of immunosuppressive therapy. All patients received Methyl Prednisolone (MP) pulse IV, oral prednisone and Cyclophosphamide (CPA) pulse IV, oral mycophenolatmophetil (MMF), and chloroquine. The individual dosage of treatment was determined according to patients’ individual conditions. Side effects of corticosteroid use were digestive tract disorders in 20% of patients, hyperglycemia in 10% of patients, hypertension in 67% of patients, and cushingsyndrome in 27% of patients. The side effects of using CPA were leukopenia in 7% of patients, Hepatotoxic in 3% of patients, and cystitishaemorrhage in 47% of patients. Side effects of using MMF were digestive tract disorders in 10% patients and leukopenia in 17% of patients. Drug interactions that found were prednisone-furosemide interactions in 60% of patients, prednisone-metformin in 10% of patients, and cyclophosphamide-allupurinol in 50% of patients. Dosage, route, and frequency of therapy for LN patients in Dr. Soetomo hospital was in accordance with the recommendations of the Clinical Practice Guide which was used as a reference in Dr. Soetomo hospital and several literatures. However, there were some patients with special conditions that requireda dosage adjustment of medication. In addition, it was necessary to monitor patients periodically for the possibility of side effects and drug interactions of immunosuppressive therapy.