Successful Treatment with Mycophenolate Mofetil and Tacrolimus in Juvenile Severe Lupus Nephritis
Lupus nephritis (LN) of juvenile onset often has severe disease presentation. Despite aggressive induction therapy, up to 20% of patients with LN are resistant to initial therapy and up to 44% suffer a renal relapse. However, there is no consensus on an appropriate therapeutic regimen for refractory...
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| Format: | Article |
| Language: | English |
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Wiley
2015-01-01
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| Series: | Case Reports in Pediatrics |
| Online Access: | http://dx.doi.org/10.1155/2015/651803 |
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| author | Tomoo Kise Hiroshi Yoshimura Shigeru Fukuyama Masatsugu Uehara |
| author_facet | Tomoo Kise Hiroshi Yoshimura Shigeru Fukuyama Masatsugu Uehara |
| author_sort | Tomoo Kise |
| collection | DOAJ |
| description | Lupus nephritis (LN) of juvenile onset often has severe disease presentation. Despite aggressive induction therapy, up to 20% of patients with LN are resistant to initial therapy and up to 44% suffer a renal relapse. However, there is no consensus on an appropriate therapeutic regimen for refractory LN. We report a 13-year-old girl with recurrent LN who was not taking her medications. At age of 11 years, she was diagnosed with LN classified as International Society of Nephrology/Renal Pathology Society (ISN/RPS) class IV G (A) + V. She was treated with prednisolone and MMF after nine methylprednisolone pulses. Nineteen months later, she was admitted to the hospital with generalized edema. Her symptoms were nephrotic syndrome and acute renal dysfunction. She received three methylprednisolone pulses for 3 days, followed by oral prednisolone and MMF. Twenty-seven days after the three methylprednisolone pulses, her acute renal dysfunction was improved, but the nephrotic syndrome was not improved. A second biopsy showed diffuse lupus nephritis classified as the predominant finding of ISN/RPS class V. We added tacrolimus to the MMF. Four months after adding tacrolimus, the nephrotic syndrome improved. We conclude that adding tacrolimus to the treatment regimen for LN resistant to MMF is effective. |
| format | Article |
| id | doaj-art-4879e1e0c5654d03bc5e0fc5b635179a |
| institution | Kabale University |
| issn | 2090-6803 2090-6811 |
| language | English |
| publishDate | 2015-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Pediatrics |
| spelling | doaj-art-4879e1e0c5654d03bc5e0fc5b635179a2025-02-03T01:01:13ZengWileyCase Reports in Pediatrics2090-68032090-68112015-01-01201510.1155/2015/651803651803Successful Treatment with Mycophenolate Mofetil and Tacrolimus in Juvenile Severe Lupus NephritisTomoo Kise0Hiroshi Yoshimura1Shigeru Fukuyama2Masatsugu Uehara3Division of Pediatric Nephrology, Okinawa Prefectural Nanbu Medical Center-Children’s Medical Center, Arakawa 118-1, Haebaru, Okinawa 901-1193, JapanDivision of Pediatric Nephrology, Okinawa Prefectural Nanbu Medical Center-Children’s Medical Center, Arakawa 118-1, Haebaru, Okinawa 901-1193, JapanDivision of Pediatric Nephrology, Okinawa Prefectural Nanbu Medical Center-Children’s Medical Center, Arakawa 118-1, Haebaru, Okinawa 901-1193, JapanDivision of Pediatric Nephrology, Okinawa Prefectural Nanbu Medical Center-Children’s Medical Center, Arakawa 118-1, Haebaru, Okinawa 901-1193, JapanLupus nephritis (LN) of juvenile onset often has severe disease presentation. Despite aggressive induction therapy, up to 20% of patients with LN are resistant to initial therapy and up to 44% suffer a renal relapse. However, there is no consensus on an appropriate therapeutic regimen for refractory LN. We report a 13-year-old girl with recurrent LN who was not taking her medications. At age of 11 years, she was diagnosed with LN classified as International Society of Nephrology/Renal Pathology Society (ISN/RPS) class IV G (A) + V. She was treated with prednisolone and MMF after nine methylprednisolone pulses. Nineteen months later, she was admitted to the hospital with generalized edema. Her symptoms were nephrotic syndrome and acute renal dysfunction. She received three methylprednisolone pulses for 3 days, followed by oral prednisolone and MMF. Twenty-seven days after the three methylprednisolone pulses, her acute renal dysfunction was improved, but the nephrotic syndrome was not improved. A second biopsy showed diffuse lupus nephritis classified as the predominant finding of ISN/RPS class V. We added tacrolimus to the MMF. Four months after adding tacrolimus, the nephrotic syndrome improved. We conclude that adding tacrolimus to the treatment regimen for LN resistant to MMF is effective.http://dx.doi.org/10.1155/2015/651803 |
| spellingShingle | Tomoo Kise Hiroshi Yoshimura Shigeru Fukuyama Masatsugu Uehara Successful Treatment with Mycophenolate Mofetil and Tacrolimus in Juvenile Severe Lupus Nephritis Case Reports in Pediatrics |
| title | Successful Treatment with Mycophenolate Mofetil and Tacrolimus in Juvenile Severe Lupus Nephritis |
| title_full | Successful Treatment with Mycophenolate Mofetil and Tacrolimus in Juvenile Severe Lupus Nephritis |
| title_fullStr | Successful Treatment with Mycophenolate Mofetil and Tacrolimus in Juvenile Severe Lupus Nephritis |
| title_full_unstemmed | Successful Treatment with Mycophenolate Mofetil and Tacrolimus in Juvenile Severe Lupus Nephritis |
| title_short | Successful Treatment with Mycophenolate Mofetil and Tacrolimus in Juvenile Severe Lupus Nephritis |
| title_sort | successful treatment with mycophenolate mofetil and tacrolimus in juvenile severe lupus nephritis |
| url | http://dx.doi.org/10.1155/2015/651803 |
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