Clinical Manifestation and Therapeutic Effect of Azathioprine in Lupus Nephritis of Children.
- Author:
Ji Suk LEE
;
Ji Hong KIM
;
Jae Seung LEE
;
Pyung Kil KIM
;
Hyun Joo JEONG
- Publication Type:Original Article
- Keywords:
Lupus nephritis;
Azathioprine;
Children;
Treatment;
Clinical manifestation
- MeSH:
Adrenal Cortex Hormones;
Azathioprine*;
Biopsy;
Child*;
Complement System Proteins;
Diagnosis;
Early Diagnosis;
Exanthema;
Female;
Fever;
Follow-Up Studies;
Hematuria;
Humans;
Immunosuppressive Agents;
Incidence;
Lupus Nephritis*;
Male;
Nephritis;
Nephrotic Syndrome;
Prognosis;
Proteinuria;
Recurrence
- From:Korean Journal of Nephrology
1998;17(6):879-886
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: The incidence of clinical nephritis is much higher especially in younger ages and in about one half of the cases, it also shows nephrotic syndrome. Thus, we examine the clinical and pathologic consideration of children with lupus nephritis and their treatment modality to improve the prognosis. MATERIAL AND METHOD: Among 67 cases of children under eighteen who were diagnosed SLE, 50 patients with hematuria and proteinuria from Jan. 1980 to Dec. 1996 were selected for the review. RESULTS: The ratio of the male to female patient was 1:3.5 and the average age at the diagnosis was 11.85+/-3.2 years old. Most common clinical manifestations at the time of the diagnosis were fever and skin rashes and the common laboratory results were proteinuria, hematuria, Out of 50 cases, 33 cases had renal biopsy. The results were 17 cases of Class IV, 7 cases of Class lll, 5 cases of Class lll, 3 cases of Class V and 1 case of Class l. Different treatment modalities were carried out; Corticosteroid only 21 cases, Corticosteroid+Azathioprine 25 cases, Corticosteroid+Cyclophosphamide 3 cases, and Corticosteroid+Cyclosporine A 1 case. However, there were no significant difference in the recurrence and complete remission rate of lupus nephritis in between each treatment groups. Average follow-up period was 37+/-23 months. Of all the follow-ups, 7 patients were dead. CONCLUSION: Early diagnosis should be carried out with renal biopsy, and should be considered for vigorous therapy, which currently includes high doses of corticosteroids and immunosuppressive drugs. Among these immunosuppressive agents, azathioprine has a lower incidence of long-term complications and low costs might be recommended. In addition, regular check-up for anti-DNA antibody, serum complement concentration and appropriate moniroting and management for the adverse effects of the treatment should enable to reach the continuous remission.
