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[Synchronization of plasmapheresis and pulse therapy in the complex treatment of children with highly active
Insights
This study found that combining plasmapheresis with pulse therapy effectively treated glomerulonephritis in most children. However, outcomes varied for complex cases like lupus nephritis and specific types of chronic glomerulonephritis.
Area of Science:
- Pediatric Nephrology
- Immunosuppressive Therapy
- Glomerular Diseases
Background:
- Glomerulonephritis, lupus nephritis, and primary chronic glomerulonephritis present significant challenges in pediatric care.
- Standard treatments often require combination therapies to manage disease activity and progression.
Purpose of the Study:
- To evaluate the efficacy of synchronous plasmapheresis and pulse therapy in pediatric patients with active glomerulonephritis.
- To assess treatment outcomes in children with various forms of glomerulonephritis, including lupus and primary chronic types.
Main Methods:
- Thirteen children with active glomerulonephritis received daily plasmapheresis for 3 days.
- Pulse therapy with cyclophosphamide or prednisolone was administered following plasmapheresis, followed by oral maintenance therapy.
Main Results:
- Ten out of thirteen pediatric patients showed beneficial therapeutic results within 3 to 6 weeks.
- Treatment was insufficient for patients with associated systemic lupus erythematosus, rapid-progressing nephritis, and mesangiocapillary glomerulonephritis with specific histological features.
- No therapeutic effect was observed in a patient with focal segmental glomerulosclerosis and persistent nephrotic syndrome.
Conclusions:
- Synchronous plasmapheresis and pulse therapy demonstrate significant efficacy in treating active pediatric glomerulonephritis.
- Treatment success is influenced by the specific type and histological characteristics of the glomerulonephritis, with less favorable outcomes in complex or advanced cases.
Abstract:
To suppress the activity of glomerulonephritis, lupus and primary chronic mixed one, 13 children received plasmapheresis synchronously with pulse therapy with cyclophosphamide or prednisolone. Plasmapheresis was carried out daily for 3 days. Six hours after the last session and on days 4 and 5 of the treatment pulse therapy was provided, followed by conventional intake of prednisolone per os in combination with azathioprine or cyclophosphamide. Beneficial therapeutic results were obtained in 10 patients within 3 to 6 weeks. The effect turned out insufficient in a patient with associated systemic lupus erythematosus, and rapid-progressing nephritis and in a child with primary chronic glomerulonephritis of the mesangiocapillary type with fibroplastic transformation and persistent nephrotic syndrome. No therapeutic effect was attained in a patient with focal segmental glomerulosclerosis running its course with long persistent nephrotic syndrome.