Lupus nephritis is a disease caused by severe complications of Systemic Lupus Erythematosus which attacks the kidneys. Therapy that is usually given to lupus nephritis patients is immunosuppressants. To determine the pattern of immunosuppressive therapy in pediatric lupus nephritis, the effectiveness and drug interactions that can be generated from these therapies. This study was an observational study with a retrospective method by observing patients’ medical record. This study populations were all pediatric patients =18 years old who were diagnosed with late onset of lupus nephritis, being hospitalized at Surabaya Hospital and had an immunosuppressive therapy history. There were 30 patients who met the inclusion criteria in this study. The sample collecting used a purposive sampling technique. The research instrument in this study was the medical record of department of pediatric in hospital of east Indonesia, Namely Dr. Soetomo. From the medical record data, we obtained information regarding the pattern of immunosuppressants administration including dosage, route, frequency of therapy, drug side effects, and drug interactions of immunosuppressive therapy. All patients received Methyl Prednisolone (MP) pulse IV, oral prednisone and Cyclophosphamide (CPA) pulse IV, oral mycophenolatmophetil (MMF), and chloroquine. The individual dosage of treatment was determined according to patients’ individual conditions. Side effects of corticosteroid use were digestive tract disorders in 20% of patients, hyperglycemia in 10% of patients, hypertension in 67% of patients, and cushingsyndrome in 27% of patients. The side effects of using CPA were leukopenia in 7% of patients, Hepatotoxic in 3% of patients, and cystitishaemorrhage in 47% of patients. Side effects of using MMF were digestive tract disorders in 10% patients and leukopenia in 17% of patients. Drug interactions that found were prednisone-furosemide interactions in 60% of patients, prednisone-metformin in 10% of patients, and cyclophosphamide-allupurinol in 50% of patients. Dosage, route, and frequency of therapy for LN patients in Dr. Soetomo hospital was in accordance with the recommendations of the Clinical Practice Guide which was used as a reference in Dr. Soetomo hospital and several literatures. However, there were some patients with special conditions that requireda dosage adjustment of medication. In addition, it was necessary to monitor patients periodically for the possibility of side effects and drug interactions of immunosuppressive therapy.
Cite this article:
Aulia Rahmawati Yulistiani, Risky Vitria Prasetyo, Evi Octavia. Immunosuppressive Therapy of Pediatric Lupus Nephritis. Research J. Pharm. and Tech 2020; 13(3):1257-1265. doi: 10.5958/0974-360X.2020.00232.2
1. Arief AR. Nefritis Lupus. J
2. Bertsias GK, Tektonidou M,
Amoura Z, Aringer M, Bajema I, Berden JHM, et al. Joint European League Against
Rheumatism and European Renal Association–European Dialysis and Transplant
Association (EULAR/ERA-EDTA) recommendations for the management of adult and
paediatric lupus nephritis. Ann Rheum Dis. 2012;71(11):1771–82.
3. Borchers AT, Leibushor N,
Naguwa SM, Cheema GS, Shoenfeld Y, Gershwin ME. Lupus nephritis: a critical
review. Autoimmun Rev. 2012;12(2):174–94.
4. Pisetsky DS. Systemic Lupus
Erythematosus B. Epidemiology, Pathology, and Pathogenesis. In: Primer on the
Rheumatic Diseases 13th Edition. New York: Springer-Verlag; 2008. p. 319–25.
5. Delafuente, J.C. dan Capuzzo
KA. Systemic Lupus Erythematosus and Other Collagen-Vascular Disease. In:
Pharmacotherapy, A Patophysiologic Approach 7th edition. USA: Mc Graw Hill
Companies, Inc; 2008. p. 1431–3.
6. Sinha R, Raut S. Pediatric
lupus nephritis: Management update. World J Nephrol. 2014;3(2):16.
7. Avner CG. Glomerulonephritis
Associated with Systemic Lupus Erythematosus. In: Nelson Textbook Of Pediatric
19th Edition. Philadelphia: Elsevier Saunder; 2011. p. 1788–9.
8. Mok CC, Lau CS. Pathogenesis
of systemic lupus erythematosus. J Clin Pathol. 2003;56(7):481–90.
9. Ruiz-Irastorza G, Danza A,
Khamashta M. Glucocorticoid use and abuse in SLE. Rheumatology.
10. Lake DF, Briggs AD,
Akporiaye ET. Immunopharmacology. In: Basic & Clinical Pharmacology 12th
edition. New York: McGraw-Hill Companies; 2012. p. 985–98.
11. Kresnky AM, Bennett WM,
Vincenti F. Immunosuppressants. In: Goodman & Gilman’s, The Pharmacological
Basis of Therapeutics 12th edition. New York: McGraw-Hill Companies; 2011. p.
12. Salgado A de Z, Herrera-Diaz
C. Lupus nephritis: an overview of recent findings. Autoimmune Dis. 2012;2012.
13. Hahn BH, Mcmahon MA, Wilkinson
A, Wallace WD, Daikh DI, Fitzgerald JD, et al. American College of Rheumatology
guidelines for screening, treatment, and management of lupus nephritis.
Arthritis Care Res (Hoboken). 2012;64(6):797–808.
14. Okpechi IG, Gcelu A, Ameh
OI. Lupus nephritis: An approach to diagnosis and treatment in South Africa.
South African Med J. 2015;105(12).
15. Agrawal N, Chiang L-K,
Rifkin IR. Lupus nephritis. In: Seminars in nephrology. Elsevier; 2006. p.
16. Chan TM. Treatment of severe
lupus nephritis: the new horizon. Nat Rev Nephrol. 2015;11(1):46.
17. Sinha A, Bagga A. Pulse
steroid therapy. Indian J Pediatr. 2008;75(10):1057.
18. Abrams AC, Pennington SS,
Lammon CB. Clinical Drug Therapy: Rationales for Nursing Practice Edition 9.
USA: Lippincott Williams & Wilkins; 2008. 352-353 p.
19. Moroni G, Ponticelli C.
Synthetic pharmacotherapy for lupus nephritis. Expert Opin Pharmacother.
20. Alves C, Robazzi TCV,
Mendonça M. Withdrawal from glucocorticosteroid therapy: clinical practice
recommendations. J Pediatr (Rio J). 2008;84(3):192–202.
21. Yong PFK, D’Cruz DP.
Mycophenolate mofetil in the treatment of lupus nephritis. Biol targets Ther.
22. Lee S-J, Silverman E,
Bargman JM. The role of antimalarial agents in the treatment of SLE and lupus
nephritis. Nat Rev Nephrol. 2011;7(12):718.
23. Coca SG, Perazella MA,
Buller GK. The cardiovascular implications of hypokalemia. Am J kidney Dis.
24. Liu D, Ahmet A, Ward L,
Krishnamoorthy P, Mandelcorn ED, Leigh R, et al. A practical guide to the
monitoring and management of the complications of systemic corticosteroid
therapy. Allergy, Asthma Clin Immunol. 2013;9(1):30.
25. Baxter K. Stockley’s drug
interactions. Vol. 495. Pharmaceutical Press London; 2008.