Pediatric Nephrology

, Volume 20, Issue 10, pp 1500–1503

Induction therapy with low-dose intravenous cyclophosphamide, oral mizoribine, and steroids for severe lupus nephritis in children

  • Shuichiro Fujinaga
  • Kazunari Kaneko
  • Yoshiyuki Ohtomo
  • Hitohiko Murakami
  • Masaru Takada
  • Shunji Akashi
  • Mayako Hira
  • Yuichiro Yamashiro
Brief Report


Although immunosuppressive regimens of corticosteroids combined with high-dose intravenous cyclophosphamide (IVCY) have been reported to suppress the activity of lupus nephritis, there is controversy regarding its application for children and adolescents, because of its potential toxicity including gonadal dysfunction. On the basis of the recent finding that a low-dose IVCY regimen for induction therapy in adult lupus nephritis effectively achieves renal remission comparable with that achieved with a conventional high-dose IVCY regimen, we treated two children with severe lupus nephritis by low-dose (fixed dose of 500 mg m−2, cumulative dose 3 g m−2, approximately one-fourth of the conventional high-dose IVCY regimen) IVCY and oral mizoribine (5 mg kg−1 day−1) and steroids (3 methylprednisolone pulse followed by oral prednisolone). They responded well to this regimen, showing remarkable improvement in both histological and clinical manifestations in a short period of time. From these findings we suggest that the new low-dose IVCY regimen may be as effective as the conventional high-dose IVCY regimen, without significant adverse effect, for induction therapy in children with severe lupus nephritis (class III or IV).


Lupus nephritis Induction therapy Mizoribine Low-dose intravenous cyclophosphamide Steroids 


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Copyright information

© IPNA 2005

Authors and Affiliations

  • Shuichiro Fujinaga
    • 1
  • Kazunari Kaneko
    • 2
  • Yoshiyuki Ohtomo
    • 1
  • Hitohiko Murakami
    • 3
  • Masaru Takada
    • 1
  • Shunji Akashi
    • 1
  • Mayako Hira
    • 4
  • Yuichiro Yamashiro
    • 4
  1. 1.Division of NephrologySaitama Children’s Medical CenterSaitamaJapan
  2. 2.Department of PediatricsKansai Medical UniversityOsakaJapan
  3. 3.Division of PathologySaitama Children’s Medical CenterSaitamaJapan
  4. 4.Department of PediatricsJuntendo University School of MedicineTokyoJapan

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