Młodzieńcza nefropatia toczniowa – leczenie dożylne cyklofosfamidem (CYP)

*Hanna Szymanik-Grzelak, Małgorzata Pańczyk-Tomaszewska, Maria Roszkowska-Blaim

Streszczenie
Introduction:In adolescents with proliferative types of lupus nephritis cyclophosphamide is used in intravenous form.
Material and methods: During 1998-2005 in 5/17 children with lupus nephropathy (LEN), (4 girls, 1 boy; aged mean – 13,6 yr), renal biopsy showed WHO: class IV in 4/5, class V – in 1/5 pts. Maximum ANA levels were 1:640-1:2560. Symptoms of LEN were: nephrotic syndrome and macroscopic haematuria (5/5), hypertension (3/5), GFR (3/5). 2 patient with GFR were treated: haemodialysis, hemofiltration, hemodiafiltration and plasmapheresis (6-9x). Before results of biopsies – all patients were given methylprednisolone pulses (mean-6x). Children were treated intravenous cyclophosphamide in initial dosage 750 mg/m² modyficated according to creatinine clearance and leucocytosis: monthly pulses for six months (6x) and then iv pulses every three months (2-7 x).
Results: During 12-27 months, patients were given cumulative dosage of CYP – mean 8220 mg/treatment/patient (range: 6000-9750 mg/treatment/patient); eg. 150 mg/kg. In periods between pulses of cyclophosphamide prednisone was used 1 mg/kg/daily, tapered individually. In 2/5 pts according to the severity of disease, during cyclophosphamide pulses, methylprednisolone pulses were given (6-8x). At the end of intravenous cyclophosphamide therapy – 4/5 patients achieved a complete clinical remission, in 3/5 pts ANA were negative.

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