CYCLOPHOSPHAMIDE AS A REMISSION-INDUCING DRUG IN A PATIENT WITH LUPUS: CASE REPORT

Authors

DOI:

https://doi.org/10.47820/recima21.v3i4.1319

Keywords:

Lupus Erythematosus, Systemic, Lupus Nephritis, Kidney Diseases, Cyclophosphamide

Abstract

Systemic Lupus Erythematosus is defined as an autoimmune disease, of chronic inflammatory character, more frequent in women of childbearing age and that typically presents multisystemic involvement, manifesting itself through periods of activity and remission, with great phenotypic variability1.  Among the various possibilities of renal involvement in SLE, Lupus Nephritis (NL) is the most common form of renal injury, affecting approximately 50% of patients1. This manifestation gains even importance because it is the main indication for the use of high doses of corticosteroids and immunosuppressants, as well as the main factor related to mortality1. The treatment of PATIENTS WITH NL aims to achieve the complete clinical response to immunosuppressive therapy, since it is directly proportional to long-term renal survival. Currently, there are guidelines such as that of the Brazilian Society of Rheumatology and the International Society of Nephrology that guide medical practice, regarding the diagnosis and treatment of NL. However, it is evident that the emergence of new medications and new therapeutic protocols make room for discussions and studies on the management of these patients. The present study aims, therefore, to discuss the remission-inducing therapy with the use of cyclophosphamide in a 35-year-old female patient with severe SLE, associated with NL and cutaneous, serous, hematological and overlap with Antiphospholipid Antibody Syndrome (SAAF).

Downloads

Download data is not yet available.

Author Biographies

  • Ulisses Dias Filho

    Universidade de Vassouras

  • Alexandre Mitsuo Mituiassu

    Médico com atuação e experiência nas áreas de Clínica Médica, Medicina Intensiva e Nefrologia. Professor do Curso de Medicina da Universidade de Vassouras. Coordenador do Serviço de Nefrologia do Hospital Universitário de Vassouras. Preceptor e coordenador da Residência Médica em Nefrologia do Hospital Universitário de Vassouras. Fundador e professor do @Mitcurso.

References

- Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Kidney Int. 2021 Oct;100(4S):S1-S276.

- Klumb EM, Silva CA, Lanna CC, Sato EI, Borba EF, Brenol JC, de Albuquerque EM, Monticielo OA, Costallat LT, Latorre LC, Sauma Mde F, Bonfá ES, Ribeiro FM. Consenso da Sociedade Brasileira de Reumatologia para o diagnóstico, manejo e tratamento da nefrite lúpica [Consensus of the Brazilian Society of Rheumatology for the diagnosis, management and treatment of lupus nephritis]. Rev Bras Reumatol. 2015 Jan-Feb;55(1):1-21.

- Parikh SV, Almaani S, Brodsky S, Rovin BH. Update on Lupus Nephritis: Core Curriculum 2020. Am J Kidney Dis. 2020 Aug;76(2):265-281.

- Balow JE, Austin HA 3rd, Muenz LR, Joyce KM, Antonovych TT, Klippel JH, Steinberg AD, Plotz PH, Decker JL. Effect of treatment on the evolution of renal abnormalities in lupus nephritis. N Engl J Med. 1984 Aug 23;311(8):491-5.

- Austin HA 3rd, Klippel JH, Balow JE, le Riche NG, Steinberg AD, Plotz PH, Decker JL. Therapy of lupus nephritis. Controlled trial of prednisone and cytotoxic drugs. N Engl J Med. 1986 Mar 6;314(10):614-9. doi: 10.1056/NEJM198603063141004. PMID: 3511372.

- Donadio JV Jr, Holley KE, Ferguson RH, Ilstrup DM. Treatment of diffuse proliferative lupus nephritis with prednisone and combined prednisone and cyclophosphamide. N Engl J Med. 1978 Nov 23;299(21):1151-5.

- Giannico G, Fogo AB. Lupus nephritis: is the kidney biopsy currently necessary in the management of lupus nephritis? Clin J Am Soc Nephrol. 2013 Jan;8(1):138-45.

- Houssiau FA, Vasconcelos C, D'Cruz D, Sebastiani GD, Garrido Ed Ede R, Danieli MG, Abramovicz D, Blockmans D, Mathieu A, Direskeneli H, Galeazzi M, Gül A, Levy Y, Petera P, Popovic R, Petrovic R, Sinico RA, Cattaneo R, Font J, Depresseux G, Cosyns JP, Cervera R. Immunosuppressive therapy in lupus nephritis: the Euro-Lupus Nephritis Trial, a randomized trial of low-dose versus high-dose intravenous cyclophosphamide. Arthritis Rheum. 2002 Aug;46(8):2121-31.

- Sinclair A, Appel G, Dooley MA, Ginzler E, Isenberg D, Jayne D, Wofsy D, Solomons N. Mycophenolate mofetil as induction and maintenance therapy for lupus nephritis: rationale and protocol for the randomized, controlled Aspreva Lupus Management Study (ALMS). Lupus. 2007;16(12):972-80.

- Canadian Hydroxychloroquine Study Group. A randomized study of the effect of withdrawing hydroxychloroquine sulfate in systemic lupus erythematosus. N Engl J Med. 1991 Jan 17;324(3):150-4.

Published

12/04/2022

How to Cite

CYCLOPHOSPHAMIDE AS A REMISSION-INDUCING DRUG IN A PATIENT WITH LUPUS: CASE REPORT. (2022). RECIMA21 - Revista Científica Multidisciplinar - ISSN 2675-6218, 3(4), e341319. https://doi.org/10.47820/recima21.v3i4.1319