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Long-term outcomes with multi-targeted immunosuppressive protocol in children with severe proliferative lupus

E Aragon1, L P Resontoc1, Y H Chan2

  • 1Shaw-NKF-NUH Children's Kidney Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.

Lupus
|November 6, 2015
PubMed

Insights

This study shows that a multi-targeted treatment protocol for children with severe lupus nephritis (LN) leads to long-term remission and kidney preservation. The treatment demonstrated good patient survival and a favorable safety profile over nearly a decade of follow-up.

Area of Science:

  • Pediatric Nephrology
  • Immunology
  • Rheumatology

Background:

  • Severe proliferative lupus nephritis (LN) in children poses significant risks for long-term kidney damage.
  • Previous one-year outcomes indicated efficacy of a multi-targeted induction protocol.
  • Long-term data are crucial for evaluating sustained remission and renal preservation in pediatric LN.

Purpose of the Study:

  • To assess the long-term renal outcomes in children with severe proliferative LN treated with a specific multi-targeted protocol.
  • To evaluate patient and renal survival, relapse-free survival, and event-free survival.
  • To analyze changes in clinical and laboratory parameters over an extended follow-up period.

Main Methods:

  • Retrospective analysis of 16 children with severe proliferative LN.
  • Treatment protocol included intravenous pulse methylprednisolone (MP), mycophenolate mofetil (MMF), and cyclosporine (CSA).
  • Long-term follow-up (median 9.2 years) assessed complete renal remission, survival rates, and clinical/laboratory markers.

Main Results:

  • All patients achieved complete renal remission within 24 months (median 8.7 months).
  • Significant improvements observed in SLEDAI scores, serum C3 levels, eGFR, and urine protein levels.
  • Cumulative ten-year renal relapse-free survival was 73.3%; 71.4% probability of avoiding hospitalization at ten years.

Conclusions:

  • The multi-targeted induction and maintenance therapy protocol is effective for long-term renal preservation in Asian children with severe proliferative LN.
  • The protocol demonstrates good patient survival and a favorable safety profile.
  • Sustained remission and improved renal function markers indicate the protocol's long-term benefits.

Keywords:
Systemic lupus erythematosuschildrencyclosporinemycophenolate mofetilproliferative lupus nephritisrenal survival

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