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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor&#44; </span></p><p class="elsevierStylePara">Lupus nephropathy &#40;LN&#41; has a direct impact on the survival of patients with systemic lupus erythematosus &#40;SLE&#41;&#46;<span class="elsevierStyleSup">1</span> Twenty percent of LN patients develop an end-stage chronic kidney disease 5-10 years after being diagnosed&#46;<span class="elsevierStyleSup">2</span> Two phases have been established for treating LN&#58; induction therapy and maintenance therapy&#46;<span class="elsevierStyleSup">3</span> We present the case of a patient diagnosed with SLE&#44; who had severe kidney damage&#46; While the patient was undergoing LN induction treatment with steroids and cyclophosphamide&#44; his kidney condition worsened&#44; having developed a severe nephritic syndrome&#46;</p><p class="elsevierStylePara">The patient was a 22-year-old man&#44; smoker&#44; with personal history of migraines and ventricular extrasystoles&#46; He had been examined by the rheumatology and haematology departments due to thrombocytopenia&#46; He was not allergic to any medication&#46;</p><p class="elsevierStylePara">The patient attended the emergency department with a fever of &#62;38&#186;C over a 10-day period&#44; with asthenia and joint pain&#46;</p><p class="elsevierStylePara">On physical examination&#44; he was in a generally good condition&#44; conscious and aware of his surroundings&#46; Blood pressure was 120&#47;80mm Hg&#59; temperature&#58; 38&#186;C&#59; heart rate&#58; 90 beats&#47;min&#46;</p><p class="elsevierStylePara">He had a bilateral malar erythema and mucocutaneous paleness&#46; He had piercings and tattoos&#46; He did not have jugular ingurgitation&#44; and the rest of the examination was normal&#46;</p><p class="elsevierStylePara">Biochemical analysis &#40;blood&#41;&#58; creatinine&#58; 1&#46;3mg&#47;dl&#59; uric acid&#58; 7&#46;2mg&#47;dl&#59; albumin&#58; 1&#46;7g&#47;dl&#59; total protein&#58; 4&#46;2g&#47;dl&#59; and the remaining parameters were normal&#46; The haemogram showed&#58; haematocrit&#58; 31&#46;3&#37;&#44; thrombocytopenia&#58; 52&#160;000&#44; and an erythrocyte sedimentation rate &#40;ESR&#41; of 22mm&#47;first hour&#46;</p><p class="elsevierStylePara">In the systematic haematuria sample and white blood count&#44; the 24-hour urine protein was 5&#46;90g&#47;24h and creatinine clearance was 71ml&#47;min&#46;</p><p class="elsevierStylePara">Immunological test had hypocomplementaemia C3&#58; 45mg&#47;dl &#40;normal value &#91;NV&#93;&#58; 79-152mg&#47;dl&#41;&#59; C4&#58; 6mg&#47;dl &#40;NV&#58;16-38mg&#47;dl&#41;&#59; normal immunoglobulins&#59; and C-reactive protein&#58; 1&#46;23mg&#47;dl &#40;NV&#58; 0-0&#46;8mg&#47;dl&#41;&#46; The autoimmunity test&#58; ANA &#43;1&#47;160 &#40;speckled pattern&#41;&#59; anti-DNA&#58; &#62;400&#59; rest of antibodies&#44; negative&#46; Indirect Coombs test was negative&#46; In the blood electrophoretic profile&#44; hypoproteinaemia and hypoalbuminaemia were detected&#46; The coagulation test was normal&#44; with positive IgG and IgM anticardiolipins&#46;</p><p class="elsevierStylePara">There were no relevant findings from the chest X-ray&#46; We saw that the patient&#8217;s kidneys were 14&#46;5cm and hyperechogenic in the kidney ultrasound&#46;</p><p class="elsevierStylePara">The SLE diagnosis was made and a kidney biopsy was performed to assess the kidney damage&#58; 40 glomeruli per cross-section were found and one of them was sclerotic&#46; All of the glomeruli had a similar diffuse proliferative appearance&#44; and more than 50&#37; &#40;36 glomeruli&#41; were associated with an extracapillary proliferation &#40;crescents&#41;&#46; Fibrinoid necrosis was also observed in some glomeruli&#44; as well as wire loops and haematoxylin bodies&#44; with positive immunofluorescence&#58; IgG &#40;&#43;&#43;&#43;&#41;&#44; IgM &#40;&#43;&#43;&#43;&#41;&#44; IgA &#40;&#43;&#43;&#43;&#41; and C3 &#40;&#43;&#43;&#43;&#41;&#46; No fibrosis or atrophy was found in the interstitial space&#44; but mild non-specific lymphocytic infiltration could be seen&#46; The activity index was 18&#47;24 and chronicity 1&#47;12&#46; The definitive diagnosis was lupus nephropathy type IV&#46;</p><p class="elsevierStylePara">Given the biopsy findings&#44; treatment with 1g i&#46;v&#46; of 6-methylprednisolone &#40;three pulses&#41;&#44; followed by prednisone 1mg&#47;kg&#47;day p&#46;o&#46; and 1g cyclophosphamide&#46; The patient was discharged and monitored on an outpatient basis&#46;</p><p class="elsevierStylePara">After being discharged &#40;14 days after having received the first cyclophosphamide pulse&#41;&#44; the patient attended the emergency department once again with joint pain for 2-3 days&#44; oedemas in the lower limbs and facial oedema&#59; gross haematuria &#40;coca-cola coloured&#41;&#44; and fever&#46; The patient said that he had completed the treatment prescribed upon discharge and had no other clinical findings that indicated infection&#46;</p><p class="elsevierStylePara">On physical examination&#44; he was in a generally good condition&#59; he was conscious and aware of his surroundings&#46; Blood pressure was 161&#47;83mm Hg&#59; temperature 36&#46;5&#186;C&#59; and heart rate 95 beats&#47;min&#46; He still had bilateral malar erythema and mucocutaneous paleness&#46; During the rest of the examination we found oedemas on the lower limbs up to the top of the thigh&#46;</p><p class="elsevierStylePara">Biochemical analysis &#40;blood&#41;&#58; creatinine&#58; 1&#46;2mg&#47;dl&#59; albumin&#58; 2&#46;7g&#47;dl&#59; total protein&#58; 4&#46;6g&#47;dl&#46; The haemogram showed that the haematocrit had decreased to 24&#46;4&#37;&#44; and the thrombocytopenia remained at 51&#160;000&#46; The remaining parameters were normal&#46;</p><p class="elsevierStylePara">The new sediment revealed macroscopic haematuria and haematic casts&#46;</p><p class="elsevierStylePara">24-hour urine protein had increased to 31g&#46;</p><p class="elsevierStylePara">In the immunological test we found a reduction in immunoglobulin G to 55mg&#47;dl&#44; with C3&#58; 83mg&#47;dl &#40;NV&#58;79-152mg&#47;dl&#41;&#59; C4&#58; 1&#46;6mg&#47;dl &#40;NV&#58; 16-38mg&#47;dl&#41; and C-reactive protein&#58; 0&#46;12mg&#47;dl&#46; The autoimmunity test&#58; ANA &#43;1&#47;80 &#40;speckled&#41;&#44; negative anti-DNA and cryoglobulins&#46;</p><p class="elsevierStylePara">The chest X-ray and Doppler kidney ultrasound did not show any pathological findings&#46; The blood culture&#44; urine culture and joint fluid culture &#40;knee&#41; were all negative&#46;</p><p class="elsevierStylePara">We repeated treatment with pulses of 1g of 6-methylprednisolone &#40;three pulses&#41; followed by prednisone at 1mg&#47;kg&#47;day and increased the cyclophosphamide pulse to 1&#46;5g&#44; which was brought forward&#46; This decision was made because the patient presented with well-developed nephritic syndrome&#44; he had lupus activity and had previously been diagnosed with type IV lupus nephropathy&#46; We also considered that renal vein thrombosis&#44; infectious processes and therapy non-adherence had already been ruled out&#46; The patient then received pulses of cyclophosphamide 1&#46;5g&#47;month &#40;6 months&#41; and cyclophosphamide 1&#46;5g &#40;every three months&#44; two cycles&#41;&#44; with a tapering regimen of steroids&#46; He was later administered a maintenance treatment with azathioprine&#46;</p><p class="elsevierStylePara">With this treatment&#44; progress was favourable&#46; The patient was not hospitalised again&#44; and kidney function normalised &#40;plasma creatinine&#58; 1&#46;1mg&#47;dl&#41; and negative proteinuria&#46; Although slight microhaematuria persisted&#44; the haemogram and immunological test normalised&#46;</p><p class="elsevierStylePara">Cyclophosphamide is considered to be the immunosuppressant with the best results in induction treatment of severe forms of proliferative LN&#46;<span class="elsevierStyleSup">4</span> After having completed the induction treatment&#44; it is possible that up to 20&#37; of LN patients do not respond adequately to induction immunosuppression&#46;<span class="elsevierStyleSup">5</span> In our case&#44; less than 2 weeks had passed since the treatment had started to be able to consider the patient non-responsive&#46; In non-responsive patients&#44; compliance must be ensured&#44; and renal vein thrombosis and infections ruled out&#46;<span class="elsevierStyleSup">3 </span>In our case&#44; the patient had received cyclophosphamide 1g in the hospital &#40;together with pulses of glucocorticoids i&#46;v&#46; and oral steroids&#44; which the patient told us he had not stopped taking&#41;&#46; We also ruled out infectious processes&#44; as well as renal vein thrombosis&#46; Nevertheless&#44; systemic manifestations relapsed and his renal condition worsened&#44; presenting with well-developed nephritic syndrome&#46; For refractory cases&#44; various therapeutic options are indicated&#44; including&#58; increasing glucocorticoid doses &#40;repeating pulses of 6-methylprednisolone&#41;&#44; repeating induction treatment with cyclophosphamide&#44; using calcineurin inhibitors&#44; mycophenolic acid&#44; plasma turnover&#44; depleting lymphocytes with rituximab&#46;<span class="elsevierStyleSup">3</span> Recent meta-analyses deem induction therapy with mycophenolate more efficient than cyclophosphamide in severe LN&#46;<span class="elsevierStyleSup">6</span> However&#44; these results should be interpreted with caution given the limitations&#58;<span class="elsevierStyleSup">3</span> Although most studies included severe LN&#44; others also included other LN forms&#44; i&#46;e&#46; type III and V&#46; That is why&#44; cyclophosphamide is the best immunosuppressant with the best result in severe LN relapse&#46;<span class="elsevierStyleSup">4</span> In our case&#44; given the severity of the process&#44; together with the biopsy findings&#44; we decided to repeat the regimen that was initially established at 1g i&#46;v&#46; pulses of 6-methylprednisolone and one pulse of cyclophosphamide i&#46;v&#46;&#44; increasing dosage to 1&#46;5g in this case&#46; After this moment&#44; the patient&#8217;s progress was satisfactory&#46; The American National Institute of Health &#40;NIH&#41;<span class="elsevierStyleSup">7</span> promotes a gold standard cyclophosphamide dose of 0&#46;75-1g&#47;m<span class="elsevierStyleSup">2</span>&#44; while the Euro-Lupus Nephropathy Trial<span class="elsevierStyleSup">2</span> states that 500mg every 15 days should be administered&#46; In our case&#44; we administered cyclophosphamide 1g at the start of treatment and in less than 15 days the patient presented systemic and renal activity again&#46; Given the favourable response after increasing the cyclophosphamide pulse to 1&#46;5g&#47;month&#44; it is possible that this lupus flare could have been due to the initial underdosing of cyclophosphamide&#46;</p><p class="elsevierStylePara">To conclude&#44; it is important to take into consideration the cyclophosphamide dosage administered before considering it to be inefficient and&#47;or assess other alternative therapy regimens&#44; as cyclophosphamide underdosing could be the cause of non-responsive patients&#46;</p>"
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                  "referenciaCompleta" => "Espinosa Garriga G, Cervera Segura R. Nuevos conceptos en el tratamiento de la nefropatía lúpica. Rev Clin Esp 2007;207:570-2. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18021647" target="_blank">[Pubmed]</a>"
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                  "referenciaCompleta" => "Burchardi C, Schlöndorff D. Induction theraphy\u{A0} for active lupus nephritis: mycophenolate mofetil versus cyclophosphamide. Nat\u{A0} Clin Pract Nephrol 2006;2:314-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16932452" target="_blank">[Pubmed]</a>"
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Cyclophosphamide-induced lupus flare in diffuse proliferative lupus nephropathy
Brote lúpico durante la inducción con ciclofosfamida en la nefropatía lúpica proliferativa difusa
M.. Herasa, A.. Saizb, M.J.. Fernández-Reyesa, R.. Sáncheza, P.. Zuritac, C.. Urregoc
a Servicio de Nefrología, Hospital General de Segovia, Segovia,
b Servicio de Anatomía Patológica, Hospital Ramón y Cajal, Madrid
c Servicio de Reumatología, Hospital General de Segovia, Segovia,
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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor&#44; </span></p><p class="elsevierStylePara">Lupus nephropathy &#40;LN&#41; has a direct impact on the survival of patients with systemic lupus erythematosus &#40;SLE&#41;&#46;<span class="elsevierStyleSup">1</span> Twenty percent of LN patients develop an end-stage chronic kidney disease 5-10 years after being diagnosed&#46;<span class="elsevierStyleSup">2</span> Two phases have been established for treating LN&#58; induction therapy and maintenance therapy&#46;<span class="elsevierStyleSup">3</span> We present the case of a patient diagnosed with SLE&#44; who had severe kidney damage&#46; While the patient was undergoing LN induction treatment with steroids and cyclophosphamide&#44; his kidney condition worsened&#44; having developed a severe nephritic syndrome&#46;</p><p class="elsevierStylePara">The patient was a 22-year-old man&#44; smoker&#44; with personal history of migraines and ventricular extrasystoles&#46; He had been examined by the rheumatology and haematology departments due to thrombocytopenia&#46; He was not allergic to any medication&#46;</p><p class="elsevierStylePara">The patient attended the emergency department with a fever of &#62;38&#186;C over a 10-day period&#44; with asthenia and joint pain&#46;</p><p class="elsevierStylePara">On physical examination&#44; he was in a generally good condition&#44; conscious and aware of his surroundings&#46; Blood pressure was 120&#47;80mm Hg&#59; temperature&#58; 38&#186;C&#59; heart rate&#58; 90 beats&#47;min&#46;</p><p class="elsevierStylePara">He had a bilateral malar erythema and mucocutaneous paleness&#46; He had piercings and tattoos&#46; He did not have jugular ingurgitation&#44; and the rest of the examination was normal&#46;</p><p class="elsevierStylePara">Biochemical analysis &#40;blood&#41;&#58; creatinine&#58; 1&#46;3mg&#47;dl&#59; uric acid&#58; 7&#46;2mg&#47;dl&#59; albumin&#58; 1&#46;7g&#47;dl&#59; total protein&#58; 4&#46;2g&#47;dl&#59; and the remaining parameters were normal&#46; The haemogram showed&#58; haematocrit&#58; 31&#46;3&#37;&#44; thrombocytopenia&#58; 52&#160;000&#44; and an erythrocyte sedimentation rate &#40;ESR&#41; of 22mm&#47;first hour&#46;</p><p class="elsevierStylePara">In the systematic haematuria sample and white blood count&#44; the 24-hour urine protein was 5&#46;90g&#47;24h and creatinine clearance was 71ml&#47;min&#46;</p><p class="elsevierStylePara">Immunological test had hypocomplementaemia C3&#58; 45mg&#47;dl &#40;normal value &#91;NV&#93;&#58; 79-152mg&#47;dl&#41;&#59; C4&#58; 6mg&#47;dl &#40;NV&#58;16-38mg&#47;dl&#41;&#59; normal immunoglobulins&#59; and C-reactive protein&#58; 1&#46;23mg&#47;dl &#40;NV&#58; 0-0&#46;8mg&#47;dl&#41;&#46; The autoimmunity test&#58; ANA &#43;1&#47;160 &#40;speckled pattern&#41;&#59; anti-DNA&#58; &#62;400&#59; rest of antibodies&#44; negative&#46; Indirect Coombs test was negative&#46; In the blood electrophoretic profile&#44; hypoproteinaemia and hypoalbuminaemia were detected&#46; The coagulation test was normal&#44; with positive IgG and IgM anticardiolipins&#46;</p><p class="elsevierStylePara">There were no relevant findings from the chest X-ray&#46; We saw that the patient&#8217;s kidneys were 14&#46;5cm and hyperechogenic in the kidney ultrasound&#46;</p><p class="elsevierStylePara">The SLE diagnosis was made and a kidney biopsy was performed to assess the kidney damage&#58; 40 glomeruli per cross-section were found and one of them was sclerotic&#46; All of the glomeruli had a similar diffuse proliferative appearance&#44; and more than 50&#37; &#40;36 glomeruli&#41; were associated with an extracapillary proliferation &#40;crescents&#41;&#46; Fibrinoid necrosis was also observed in some glomeruli&#44; as well as wire loops and haematoxylin bodies&#44; with positive immunofluorescence&#58; IgG &#40;&#43;&#43;&#43;&#41;&#44; IgM &#40;&#43;&#43;&#43;&#41;&#44; IgA &#40;&#43;&#43;&#43;&#41; and C3 &#40;&#43;&#43;&#43;&#41;&#46; No fibrosis or atrophy was found in the interstitial space&#44; but mild non-specific lymphocytic infiltration could be seen&#46; The activity index was 18&#47;24 and chronicity 1&#47;12&#46; The definitive diagnosis was lupus nephropathy type IV&#46;</p><p class="elsevierStylePara">Given the biopsy findings&#44; treatment with 1g i&#46;v&#46; of 6-methylprednisolone &#40;three pulses&#41;&#44; followed by prednisone 1mg&#47;kg&#47;day p&#46;o&#46; and 1g cyclophosphamide&#46; The patient was discharged and monitored on an outpatient basis&#46;</p><p class="elsevierStylePara">After being discharged &#40;14 days after having received the first cyclophosphamide pulse&#41;&#44; the patient attended the emergency department once again with joint pain for 2-3 days&#44; oedemas in the lower limbs and facial oedema&#59; gross haematuria &#40;coca-cola coloured&#41;&#44; and fever&#46; The patient said that he had completed the treatment prescribed upon discharge and had no other clinical findings that indicated infection&#46;</p><p class="elsevierStylePara">On physical examination&#44; he was in a generally good condition&#59; he was conscious and aware of his surroundings&#46; Blood pressure was 161&#47;83mm Hg&#59; temperature 36&#46;5&#186;C&#59; and heart rate 95 beats&#47;min&#46; He still had bilateral malar erythema and mucocutaneous paleness&#46; During the rest of the examination we found oedemas on the lower limbs up to the top of the thigh&#46;</p><p class="elsevierStylePara">Biochemical analysis &#40;blood&#41;&#58; creatinine&#58; 1&#46;2mg&#47;dl&#59; albumin&#58; 2&#46;7g&#47;dl&#59; total protein&#58; 4&#46;6g&#47;dl&#46; The haemogram showed that the haematocrit had decreased to 24&#46;4&#37;&#44; and the thrombocytopenia remained at 51&#160;000&#46; The remaining parameters were normal&#46;</p><p class="elsevierStylePara">The new sediment revealed macroscopic haematuria and haematic casts&#46;</p><p class="elsevierStylePara">24-hour urine protein had increased to 31g&#46;</p><p class="elsevierStylePara">In the immunological test we found a reduction in immunoglobulin G to 55mg&#47;dl&#44; with C3&#58; 83mg&#47;dl &#40;NV&#58;79-152mg&#47;dl&#41;&#59; C4&#58; 1&#46;6mg&#47;dl &#40;NV&#58; 16-38mg&#47;dl&#41; and C-reactive protein&#58; 0&#46;12mg&#47;dl&#46; The autoimmunity test&#58; ANA &#43;1&#47;80 &#40;speckled&#41;&#44; negative anti-DNA and cryoglobulins&#46;</p><p class="elsevierStylePara">The chest X-ray and Doppler kidney ultrasound did not show any pathological findings&#46; The blood culture&#44; urine culture and joint fluid culture &#40;knee&#41; were all negative&#46;</p><p class="elsevierStylePara">We repeated treatment with pulses of 1g of 6-methylprednisolone &#40;three pulses&#41; followed by prednisone at 1mg&#47;kg&#47;day and increased the cyclophosphamide pulse to 1&#46;5g&#44; which was brought forward&#46; This decision was made because the patient presented with well-developed nephritic syndrome&#44; he had lupus activity and had previously been diagnosed with type IV lupus nephropathy&#46; We also considered that renal vein thrombosis&#44; infectious processes and therapy non-adherence had already been ruled out&#46; The patient then received pulses of cyclophosphamide 1&#46;5g&#47;month &#40;6 months&#41; and cyclophosphamide 1&#46;5g &#40;every three months&#44; two cycles&#41;&#44; with a tapering regimen of steroids&#46; He was later administered a maintenance treatment with azathioprine&#46;</p><p class="elsevierStylePara">With this treatment&#44; progress was favourable&#46; The patient was not hospitalised again&#44; and kidney function normalised &#40;plasma creatinine&#58; 1&#46;1mg&#47;dl&#41; and negative proteinuria&#46; Although slight microhaematuria persisted&#44; the haemogram and immunological test normalised&#46;</p><p class="elsevierStylePara">Cyclophosphamide is considered to be the immunosuppressant with the best results in induction treatment of severe forms of proliferative LN&#46;<span class="elsevierStyleSup">4</span> After having completed the induction treatment&#44; it is possible that up to 20&#37; of LN patients do not respond adequately to induction immunosuppression&#46;<span class="elsevierStyleSup">5</span> In our case&#44; less than 2 weeks had passed since the treatment had started to be able to consider the patient non-responsive&#46; In non-responsive patients&#44; compliance must be ensured&#44; and renal vein thrombosis and infections ruled out&#46;<span class="elsevierStyleSup">3 </span>In our case&#44; the patient had received cyclophosphamide 1g in the hospital &#40;together with pulses of glucocorticoids i&#46;v&#46; and oral steroids&#44; which the patient told us he had not stopped taking&#41;&#46; We also ruled out infectious processes&#44; as well as renal vein thrombosis&#46; Nevertheless&#44; systemic manifestations relapsed and his renal condition worsened&#44; presenting with well-developed nephritic syndrome&#46; For refractory cases&#44; various therapeutic options are indicated&#44; including&#58; increasing glucocorticoid doses &#40;repeating pulses of 6-methylprednisolone&#41;&#44; repeating induction treatment with cyclophosphamide&#44; using calcineurin inhibitors&#44; mycophenolic acid&#44; plasma turnover&#44; depleting lymphocytes with rituximab&#46;<span class="elsevierStyleSup">3</span> Recent meta-analyses deem induction therapy with mycophenolate more efficient than cyclophosphamide in severe LN&#46;<span class="elsevierStyleSup">6</span> However&#44; these results should be interpreted with caution given the limitations&#58;<span class="elsevierStyleSup">3</span> Although most studies included severe LN&#44; others also included other LN forms&#44; i&#46;e&#46; type III and V&#46; That is why&#44; cyclophosphamide is the best immunosuppressant with the best result in severe LN relapse&#46;<span class="elsevierStyleSup">4</span> In our case&#44; given the severity of the process&#44; together with the biopsy findings&#44; we decided to repeat the regimen that was initially established at 1g i&#46;v&#46; pulses of 6-methylprednisolone and one pulse of cyclophosphamide i&#46;v&#46;&#44; increasing dosage to 1&#46;5g in this case&#46; After this moment&#44; the patient&#8217;s progress was satisfactory&#46; The American National Institute of Health &#40;NIH&#41;<span class="elsevierStyleSup">7</span> promotes a gold standard cyclophosphamide dose of 0&#46;75-1g&#47;m<span class="elsevierStyleSup">2</span>&#44; while the Euro-Lupus Nephropathy Trial<span class="elsevierStyleSup">2</span> states that 500mg every 15 days should be administered&#46; In our case&#44; we administered cyclophosphamide 1g at the start of treatment and in less than 15 days the patient presented systemic and renal activity again&#46; Given the favourable response after increasing the cyclophosphamide pulse to 1&#46;5g&#47;month&#44; it is possible that this lupus flare could have been due to the initial underdosing of cyclophosphamide&#46;</p><p class="elsevierStylePara">To conclude&#44; it is important to take into consideration the cyclophosphamide dosage administered before considering it to be inefficient and&#47;or assess other alternative therapy regimens&#44; as cyclophosphamide underdosing could be the cause of non-responsive patients&#46;</p>"
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ISSN: 20132514
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