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Effect of Low-Dose Cyclosporine A in the Treatment of Refractory Proteinuria in Childhood-Onset Lupus Nephritis

Department of Rheumatology, vicbaca{at}prodigy.net.mx

T Catalán

Department of Rheumatology

M Villasís-Keever

Clinical Epidemiology Research Unit

G Ramón

Department of Pathology

AM Morales

Department of Nephrology, Hospital de Pediatría Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), México, D.F., México

F Rodríguez-Leyva

Department of Nephrology, Hospital de Pediatría Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), México, D.F., México

We performed a prospective study to evaluate the efficacy and safety of low-dose cyclosporine A (CSA) treatment in paediatric lupus nephritis refractory to conventional therapy. Seven children with biopsy-proven Class III—IV lupus nephritis were treated with CSA (2—4 mg/kg/day) combined with low-dose prednisone for one year. All patients had failed to achieve sustained proteinuria remission with corticosteroids and cytotoxic drugs. Proteinuria decreased from median value of 2.5 g/24 hours (range, 1.2—4.9) to 0.14 g/24 hours (range, 0.0—0.84) after treatment (P = 0.018). Median values of creatinine clearance and serum creatinine did not change significantly. Median systemic lupus erythematosus disease activity index score decreased from 12 (range, 6—16) to 4 (range, 0—8) at end of treatment (P = 0.027). However, two patients experienced flares of extrarrenal manifestations and complement levels did not improve. Moreover, most patients relapsed with proteinuria within a few months of stopping CSA therapy. Side effects were not significant. In conclusion, low-dose of CSA combined with steroids appears to be useful to reduce proteinuria in paediatric proliferative lupus nephritis refractory to steroids and cytotoxic drugs; however, relapses are common after CSA discontinuation. Further studies are needed to define the precise role of CSA in paediatric lupus nephritis.

Key Words: cyclosporine A • lupus nephritis • systemic lupus erythematosus • childhood

Lupus, Vol. 15, No. 8, 490-495 (2006)
DOI: 10.1191/0961203306lu2312oa


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