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Fatal infection in children with lupus nephritis treated with intravenous cyclophosphamide

Kamolwish Laoprasopwattana1, Pornsak Dissaneewate, Prayong Vachvanichsanong

  • 1Department of Pediatrics, Prince of Songkla University, Songkhla, Thailand. kamolwish@yahoo.com

Pediatric Nephrology (Berlin, Germany)
|March 13, 2009
PubMed

Insights

Fatal infections in childhood lupus nephritis (LN) patients treated with intravenous cyclophosphamide (IVCY) are linked to prior pulse methylprednisolone, renal failure, and fungal infections. Early identification of fungal infections is crucial for improving outcomes.

Area of Science:

  • Pediatric Nephrology
  • Infectious Diseases
  • Immunology

Background:

  • Childhood lupus nephritis (LN) treatment often involves immunosuppressants like intravenous cyclophosphamide (IVCY).
  • Severe infections pose a significant risk to patients with LN undergoing immunosuppressive therapy.
  • Understanding risk factors for fatal infections is crucial for optimizing treatment strategies.

Purpose of the Study:

  • To identify the causes and risk factors associated with fatal infections in children with lupus nephritis treated with IVCY.
  • To inform clinical practice and improve patient outcomes by elucidating predictors of mortality.

Main Methods:

  • Retrospective analysis of 84 childhood lupus nephritis patients treated between 1996-2007.
  • Detailed review of severe infection episodes, causative organisms, and patient characteristics.
  • Multivariate analysis to determine independent risk factors for fatal infections.

Main Results:

  • 36.9% of patients experienced severe infections, with a 41.9% mortality rate among those infected.
  • Major causes of fatal infections included fungi and Gram-negative bacilli.
  • Risk factors for fatal infection included prior pulse methylprednisolone, renal failure, and fungal infection.

Conclusions:

  • Prior pulse methylprednisolone, renal failure, and fungal infections are significant predictors of fatal outcomes in childhood LN patients on IVCY.
  • Aggressive investigation for fungal infections is warranted in patients with active LN, IVCY, and pulse methylprednisolone who develop severe, antibiotic-refractory infections.

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