Good outcomes with mycophenolate-cyclosporine-based induction protocol in children with severe proliferative lupus nephritis

Abstract

The outcomes of children with severe proliferative lupus nephritis (LN) were examined using a new mycophenolate and cyclosporine-based (MMF—CSA) induction protocol. Sixteen children with LN (WHO class III and IV), 31.3% of whom required dialysis at induction, were retrospectively studied. Median MMF dose was 942 mg/m2/day. Thirteen patients (81%) with persistent proteinuria received CSA. Clinical and laboratory parameters were compared at pre-induction, 6 and 12 months. Treatment outcome was defined by Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), renal function, haematuria, proteinuria and serological markers (complements C3, C4 and anti-dsDNA). Comparing these parameters at induction, 6 months and 12 months, respectively, SLEDAI (25.4 ± 8.7 versus 3.2 ± 2.9 versus 2.9 ± 2.8), serum C3 (47 ± 21 versus 107 ± 27 versus 111 ± 38 mg/dl), C4 (12 ± 14 versus 23 ± 14 versus 22 ± 11 mg/dl) and urine protein (6.97 ± 7.09 versus 0.98 ± 1.56 versus 0.21 ± 0.13 g/ day/1. 73 m2) improved significantly (p < 0.05). Anti-dsDNA titres decreased in 73% by 6 and 12 months (p < 0.05). Complete renal remission was achieved in 7/16 (43.8%) at 6 months and 12/16 (75%) at 12 months, the rest achieving partial remission with no treatment failures. In conclusion, a combination MMF—CSA protocol is an effective therapeutic alternative for induction of children with severe proliferative LN, resulting in significant clinical and serological improvement with minimal adverse effects.