MDcooper
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28 year ols female
diagnosed with lupus nephritis TYPE IV.She has malar rash,diffuse arthritis and edema.
BP is 190/110,Creatinine =2.1,BUN=28.Urine reveals 25 RBCs per hpf and 3+ protiens.One red cell cast is seen.24 Hr urine collection reveals protien of 11 grams with creatinine of 1 gm.Which of the following would be the most appropriate management?
A.oral azothioprin
B.oral cyclophosphamode
C.oral gold
D.oral prednisone
E.pulse IV cyclophosphamide
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| saadtazjam
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E
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| MDcooper
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what is pulse cyclophosphamide?
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| saadtazjam
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Pulse with a dose then stop and pulse again in order for the Kidneys to recover......????
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| study_ing
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wud appreciate reasons as to y E and y not the others..
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| saadtazjam
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http://www.prep4usmle.com/forum/thread/33885
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| study_ing
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thanx  god bless u
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| study_ing
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http://bmj.bmjjournals.com/cgi/content/full/330/7...
was a nice focussed editorial in BMJ. also talked abt recent stuff compared to traditional oneeg
pregnancy is no more a contraindication in SLE
"Lupus nephritis considerably increases pregnancy related maternal and fetal morbidity risks but these risks can now be managed, providing the nephritis is quiescent at conception."
rituximab and mycophenolate are interesting new developments with a lot of potential. IVIG are not yet.
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| study_ing
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http://www.emedicine.com/med/topic1597.htm#sectio...
- Therapies for renal biopsy–specific pathologic lesions
- Class I lesions require no specific therapy.
For class II lesions, treatment of extrarenal manifestations may be the only therapy required. i some cases prednisone -
- With class III and IV lesions, patients are at high risk of progressing to end-stage renal disease and require aggressive therapy.
- For class V lesions, patients are generally treated with prednisone for 1-3 months, followed by tapering for 1-2 years if a response occurs or, if no response occurs, by discontinuation.
- Immunosuppressive drugs are generally not used unless worsening renal function or a proliferative component is present on renal biopsy samples.
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