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        "resumen" => "Intravenous cyclophosphamide &#40;IVCP&#41; in combination with oral steroids &#40;ST&#41; is the most widely accepted therapy for severe lupus nephritis &#40;LN&#41;&#59; however&#44; its side effects&#44; lack of response and relapses&#44; have led to other treatment alternatives&#46; being sought&#46; Mycophenolate mofetil &#40;MMF&#41; has been shown to be effective in these cases&#46; We studied the course over 12 months of 28 patients with LN WHO class III&#40;n&#61;3&#41;&#44; IV&#40;n&#61;22&#41; or V&#40;n&#61;3&#41;&#44; with 38&#44;1 &#177; 11&#44;4 tears of age&#44; proteinuria 4&#44;2 &#177; 2&#44;6 g &#47;24 hours and serum creatinine 1&#44;4 &#177; 0&#44;8 mg&#47;dL&#44; who&#44; after being initially treated with ST and IVCP&#44; showed no response&#40;n&#61;21&#41;&#44; frequent relapses&#40;n&#61;6&#41;&#44; or adverse side effects&#40;n&#61;1&#41;&#46; All patients were treated with MMF in doses of 1000 to 2000 mg&#47;day combined with ST or cyclosporine for one year&#46; Four patients withdrew from treatment before the end of the follow-up&#46; None of the patients who completed the study showed changes in hematologic parameters&#46; Creatinine and creatinine clearance remained stable&#46; Resulted in a significant improvement&#59; serum albumine &#40;3 &#177; 0&#44;8 vs 3&#44;9 &#177; 0&#44;5 g&#47;dL&#41; p <0 01 and decreased of proteinuria 4 2 6 vs 1 8 g 24 hours p <0 05 complement fractions improvement significantly c3 and ch50 p <0 05 c4 p <0 01 antinuclear antibodies ana and anti-dna decreased significantly p <0 05 during follow-up a reduction in the st dose was achieved: 18 3 10 5 vs 1 4 mg 24h p <0 01 three mild side effects related to mmf were observed and only 1 case required discontinuation of treatment we concluded that is a useful drug in the control lupus nephritis which also allows for significant reduction dose st with minimal</0> </0> </0> </0> </0> </0>"
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Vol. 27. Issue. 4.August 2007
Pages 399-525
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Vol. 27. Issue. 4.August 2007
Pages 399-525
DOI:
Mycophenolate mofetil in the treatment of lupus nephritis, in patients with failure, intolerance or relapses after treatment with steroids and cyclophosphamide
Micofenolato mofetil en el tratamiento de la nefritis lúpica en pacientes con fracaso, intolerancia o recidivas tras tratamiento con esteroides y ciclofosfamida
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Santiago Suria González Nefrología Hospital Universitario Insular de Gran Canaria, María Dolores Checa Andrés Nefrología Hospital Universitario Insu
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Intravenous cyclophosphamide (IVCP) in combination with oral steroids (ST) is the most widely accepted therapy for severe lupus nephritis (LN); however, its side effects, lack of response and relapses, have led to other treatment alternatives. being sought. Mycophenolate mofetil (MMF) has been shown to be effective in these cases. We studied the course over 12 months of 28 patients with LN WHO class III(n=3), IV(n=22) or V(n=3), with 38,1 ± 11,4 tears of age, proteinuria 4,2 ± 2,6 g /24 hours and serum creatinine 1,4 ± 0,8 mg/dL, who, after being initially treated with ST and IVCP, showed no response(n=21), frequent relapses(n=6), or adverse side effects(n=1). All patients were treated with MMF in doses of 1000 to 2000 mg/day combined with ST or cyclosporine for one year. Four patients withdrew from treatment before the end of the follow-up. None of the patients who completed the study showed changes in hematologic parameters. Creatinine and creatinine clearance remained stable. Resulted in a significant improvement; serum albumine (3 ± 0,8 vs 3,9 ± 0,5 g/dL) p <0 01 and decreased of proteinuria 4 2 6 vs 1 8 g 24 hours p <0 05 complement fractions improvement significantly c3 and ch50 p <0 05 c4 p <0 01 antinuclear antibodies ana and anti-dna decreased significantly p <0 05 during follow-up a reduction in the st dose was achieved: 18 3 10 5 vs 1 4 mg 24h p <0 01 three mild side effects related to mmf were observed and only 1 case required discontinuation of treatment we concluded that is a useful drug in the control lupus nephritis which also allows for significant reduction dose st with minimal
Keywords:
Systemic lupus erythematosus
Lupus nephritis
Mycophenolate mofetil
Steroids
Cyclophosphamide
La asociación de Esteroides orales y Ciclofosfamida intravenosa en bolos, es la pauta terapéutica más aceptada en la Nefritis Lúpica severa. Los efectos secundarios, así como los casos de falta de respuesta y recidivas han hecho que se busquen otras alternativas terapéuticas. El Micofenolato Mofetil se ha mostrado eficaz en estos casos. Hemos estudiado la evolución, a lo largo de 12 meses, de 28 pacientes afectos de Nefritis Lúpica clase III(n=3), IV(n=22) y V(n=3), según la clasificación de la Organización Mundial de la Salud, con edad de 38,1 ± 11,4 años, todos presentaban proteinuria y en la mitad de ellos era mayor de 3,5 g/24 horas, la creatinina sérica fue 1,4 ± 0,8 mg/dL. Habiendo sido tratados inicialmente con esteroides y Ciclofosfamida intravenosa en bolos, habían presentado falta de respuesta(n=21), recidivas frecuentes(n=6), o efectos secundarios adversos(n=1). Todos ellos han sido tratados, durante 12 meses, con Micofenolato Mofetil con dosis de 1000 a 2000 mg/día asociado a esteroides o Ciclosporina durante un año. Cuatro pacientes abandonaron el tratamiento antes de finalizar el periodo. Observamos incremento de albúmina sérica 3 ± 0,8 vs 3,9 ± 0,5 g/dL), p <0 01 descenso de la proteinuria en 24 horas 4 2 6 vs 1 8 g p <0 05 las fracciones del complemento mejoraron c3 y ch50 p <0 05 c4 p <0 01 los anticuerpos anti nucleares y dna descendieron de forma significativa p <0 05 a lo largo del seguimiento se logro una reducción de la dosis esteroides: 18 3 10 5 vs 1 4 mg 24h p <0 01 se observaron 3 acontecimientos adversos leves relacionados con el mmf y solo 1 caso precisó suspensión del tratamiento concluimos que micofenolato mofetil es un fármaco útil en control de la nefritis lúpica permite además una reducción significativa dosis esteroides mínimos efectos secundarios
Palabras clave:
Lupus eritematoso sistémico
Nefritis lúpica
Micofenolato mofetil
Esteroides
Ciclofosfamida

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