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Internal Medicine

Answer 4
  1. Mycophenolate mofetil. In the past, glucocorticoids and cyclophosphamide were the treatments of choice in patients with proliferative nephritis. High-dose steroids given as IV boluses (pulse therapy) were effective for rapidly controlling acute glomerular inflammation. Cyclophosphamide is an important adjunct to steroid therapy and has effectively preserved renal function over the long term as compared with steroids alone.4 Cyclophosphamide administered as an IV bolus is as efficacious as oral therapy and appears to be less toxic. The currently recommended initial regimen for a patient with proliferative nephritis is mycophenolate mofetil 1 g twice daily for the first 6 months followed by 0.5 mg for 6 months. The patient should be treated for lupus nephritis for 1 year with the goals of inducing remission, maintaining effective prophylaxis against relapse, and prevention of renal failure. Mycophenolate mofetil has been proven to be better tolerated than IV cyclophosphamide.5

     Contreras G, Pardo V, Leclercq B, et al. Sequential therapies for proliferative lupus nephritis. N Engl J Med 2004;350:971-80.

    5. Ginzler EM, Dooley MA, Aranow C, et al. Mycophenolate mofetil or intravenous cyclophosphamide for lupus nephritis. N Engl J Med 2005;353:2219-27.

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