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Kise T.,Prefectural Okinawa Nanbu Medical Center | Yoshimura H.,Prefectural Okinawa Nanbu Medical Center
Japanese Journal of Nephrology | Year: 2012

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/m 2/day, increased to 1 g/m 2/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. Source

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