phuluong2k
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1.10)
A 28-year-old woman is diagnosed with lupus nephritis, World Health Organization (WHO) type IV. She has a malar rash, diffuse arthritis, and edema. Her blood pressure is 190/110 mm Hg. Her creatinine is 2.1 mg/dL with a blood urea nitrogen of 28 mg/dL. Her urine reveals 25 red blood cells per hpf, and 3+ protein. One red blood cell cast is seen. A 24-hour urine collection reveals a protein of 11 grams with a creatinine of 1 gram. Which of the following would be the most appropriate management?
A. Oral azathioprine
B. Oral cyclophosphamide
C. Oral gold
D. Oral prednisone
E. Pulse IV cyclophosphamide
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| nisha
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D.?
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| chemamr
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E?
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| mani
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B. Oral cyclophosphamide i think
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| kabu
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B. - cyclo is used for life threatening manifestn of SLE. High dose pulse IV cyclo may be less toxic but also less immunosuppresive than oral cyclo daily low dose PO. Azathioprine and mycophenolate mofetil are used more often as steroid sparing agents but may not be as effective as cyclo in treating nephritis. (Wash manual of Therap)
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| chemamr
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which is the answer phuluong??? 
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| Dot
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WHO Grade IV Lupus nephritis- Most appropriate management is Oral CYclophospahamide.Study conducted by NIH U.S shows oral therpy better than i.v pulse therpy.I would like to add that cyclophosphamide takes 2-3 weeks for its action to ocur so if lifethreatening condition start steriod with cyclophosphamide
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| phuluong2k
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E. The most effective treatment for aggressive systemic lupus erythematosus with nephritis is pulse cyclophosphamide. This has been shown to be the best agent to treat type IV lupus nephritis.
Oral cyclophosphamide (choice B) is effective but not as effective as the pulse IV form.
Oral gold (choice C) is used to treat rheumatoid arthritis.
Oral prednisone (choice D) and oral azathioprine (choice A) are other commonly used agents but are not as effective as cyclophosphamide.
My Q source is not official, so you can verify it's explanation
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| Dot
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My sourse is HARRISON.
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| kabu
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I agree with Dot - Both Harrison and Washington Manual of Therapeutics can't be wrong. I know you're just posting the q's - somebody just sttructured it wrong.
I'm also posting q's from elsewhere- so this is the risk we take. Anyway its not the answers I worry about -its a learning process and all this does is makes us think as a group and feel less alone in this step 2 struggle.
Thats how I see it anyway.
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| phuluong2k
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Hi, I ve just check harrison, can't look for the advantage of PO cyclophosphomide versus pulse IV,
harrison 16th edition
page 1682
Intravenous pulse cyclophosphamide is as efficacious as oral therapy & appears to be less toxic
page 1966
The mainstay of treatment of any inflammatory life threatening or organ threatening manifestation of SLE is systemic glucocorticoid prednisone PO or Methylprednisolone IV
Cytotoxic drugs are another important class used to treat serious SLE, Cyclophosphamide has become the standard drugsused for control life threatening active lupus, particularly in in patient s whose renal biopsies shows who GRADE III, IV, & V proliferative or membranoproliferative form of nephritis. All sucessful studies with cyclophosphamide have also used concomitent glucocorticoid therapy.
Another reference, but less liable
www.outlinemed.com/demo/nephrol/4958.htm
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