Kidney disease Proteinurik Son

In the codes of conduct various kidney disease focal segmental proteinurik as glomerulosklerosis (GSFS), nephrotic syndrome survive steroids, and others have used kortiko-steroids, siklofosfamid, klorambusil, and given an oral siklosforin in a long time with different results . Despite many reports of success, but poor for a variety of things such as irregularity take medicine, take medicine that is not continuous, or high infection display, until researchers find a treatment with better results and side effects are rare. Puls therapy (pulse therapy is one treatment option for kidney disease this proteinurik. Puls usual therapy in children is metilprednisolon and siklofosfamid. To increase the number of success, then puls therapy is usually combined with oral corticosteroids or drugs alkilating.

Puls therapy is a high dose of medication at once by way of an intravenous bolus. Literature shows that puls therapy has been used against various diseases such as Rheumatoid Vasculitis, rheumatoid arthritis, multiple sclerosis, granulomatosis Wagener, eosinofilik lung disease, idiopathic pulmonary hemosi-derosis, leukemia, and some kidney disease. Some kidney diseases of children are not responsive to oral corticosteroids and imunosupresan puls terindikasi for therapy.

In several studies proved that siklofosfamid metilprednisolon puls puls and more effective than oral siklofosfamid and high dose oral steroids induces remission and prevention of terminal renal failure with lesser side effects.

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Puls Therapy Kidney Disease Proteinurik Son part 1

Guidance

Some kidney disease ditatalaksana proteinurik children with puls therapy, among others: class IV lupus nephritis or proliferative lupus nephritis difus, systematic lupus erythematosus temik Infantile, glomerulosklerosis focal segmental (GS-FS), membranoprolifetarif glomerulonephritis type I, Henoch-Schonlein purpura nephritis heavy, heavy glomerulonephritis, nephrotic syndrome and steroid survive.

Way
Medications are often used in therapy puls is metilprednisolon dose 15-30 mg / kgbb / day and cyclo-fosfamid 500-1000 mg / kgbb / day.

There are many ways giving puls therapy.

1. Metilprednisolon

a. Metilprednisolon with a dose of 30 mg / kgbb (maximum 1500 mg) was dissolved in 50-100 ml dekstrose 5%, given by infusion for 1 hour or can be for 6 hours. As long as the necessary monitoring of vital signs, especially blood pressure and heart frequency. Puls therapy is given every other day three times a week on weeks 1 and 2. During weeks 3 to 10 methyl-prednisolone 30 mg / kgbb given once a week, week 11 to 18 metilprednisolon 30 mg / kgbb given every 2 weeks, at week 19 to 50 metilprednisolon 30 mg / kgbb given every 4 weeks, and during the week 51 up to 82 metilprednisolon 30
mg / kgbb given every 8 weeks. Starting week three with oral doses given prednison 2 mg / kgbb / day every other day and week eleven prednison down slowly until week 82.

If the treatment is improvement of living there, so drugs are not given alkilating. Alkilating drug is given if there has been a persistent nephrotic proteinuri after 10 weeks of treatment metilprednisolon puls or if initially there is improvement, but accompanied by an increase proteinuri means. Cyclo-fosfamid usually given 2 to 2.5 mg / kgbb / day or klorambusil 0.2 mg / kgbb / day for 8-12 weeks.

b. Puls Metilprednisolon 1000 mg / 1.73 m2 LPB provided with the help of infusion pumps in 6 hours 3 times every other day. After it was given 30 mg/m2 prednison LPB every day for a month, then 30 mg / m2 per-day intervals LPB for 2 months, and 15 mg/m2 LPB every other day for 2 weeks. Empowerment series
puls metilprednisolon can be extended to 8 months to 4 years, depending on the clinical symptoms of disease.

c. Bergstein and Andreoli (1995) gave methyl-prednisolone puls 30 mg / kgbb / dose (maximum 1.5 g) infused intravenously in 50-100 ml of liquid dekstrose 5% for 30-60 minutes, is given every day 6 times followed by prednison 2 mg / kgbb / day (maximum 60 mg / day) single dose every other day for an average of 37 months (12-66 months) or prednison 2 mg / kgbb / day for 1 month and to then, slowly revealed. (8,10,17) Termination of treatment depends on the stability of the clinical disease.

2. Siklofosfamid

a. Siklofosfamid LPB 500 mg/m2 in 250 ml NaCl 0.9%, given by infusion slowly within 3-4 hours to reduce the risk of nausea and vomiting. In addition to being organized is also giving an oral liquid with a large number of 24 hours and often advisable to reduce the risk of new bladder hemoragik reefs. Puls Siklofosfamid given every month for six months. LPB Prednison 60 mg/m2 given every day for two months, followed by a grant every other day
(Alternate days) for 4 months, and a further dose 30 mg/m2 LPB every other day for 6 months. One year after the initial dose intravenous and prednison siklofosfamid, steroids down slowly 10 mg per month, and stopped in 2-6 months, depending on the initial dose.

b. Puls Siklofosfamid given in 100-150 ml dekstrose 5% for 1 hour followed by hydration with 5% in the infusion dekstrose NaCl 0.5% 2 l/m2 LPB given for 24 hours. After the initial grant, siklofosfamid puls given every month for 6 months and up to 7 doses and was continued every 3 months to 3 years. At the beginning of cyclo-fosfamid given dose of 500 mg/m2 LPB, LPB increased to 750 mg/m2 to 1000 mg / m2 LPB.

c. Puls Siklofosfamid dose of 750 mg/m2 given by LPB. After therapy siklofosfamid puls, patients received intravenous hydration for 24 hours and organized frequent bladder. Puls siklofosfamid Initially given every 1-2 months depending on disease activity. Dose reduced if klirens creatinine <40 ml / min. After a dose of a total of 6 times, the treatment stopped if there is no active form of the disease. This dose can be extended up to 2 or 3 times 6 doses. Prednison 1 mg / kgbb / day given every day for 6 weeks, then reduced to 40 mg and 20 mg every other day.

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Puls Therapy Kidney Disease Proteinurik Son part 2

Advanced part 1 ....

There are many ways giving puls therapy

d. Puls Siklofosfamid given by infusion for 1 hour with a dose of 500 mg-1, 000 mg/m2 LPB and done with organized adekuat hydration bladder frequently. Puls Siklofosfamid is given every 3 months for 4 years or until at least 18 months in remission.

e. Puls Siklofosfamid given every month for 12 months with a dose of 500 mg/m2 in the first month LPB, 750 mg/m2
LPB in the second, and a further 1000 mg / m2 LPB.

f. Siklofosfamid puls with the dose 750 mg-1, 000 mg/m2 given every month LPB to 6 months followed by a puls sikofosfamid the same dose every 3 months for 2 -3 years. Prednison given with a dose 0.5 mg / kgbb / day and then lowered slowly.

3. Metilprednisolon with siklofosfamid

a. Metilprednisolon puls 20 mg / kgbb / day given in 2 hours for 3 days. After giving intravenous metilprednisolon, carried out by intravenous hydration followed by a grant siklofosfamid LPB 500 mg/m2 plus Mesna (uromitexan) 360 mg/m2 in 100 ml LPB dekstrose 5% of each 2-hour infusion, followed by intravenous hydration. Mesna infusion given again after 2-4 hours, 6 hours and 10 hours. After metilprednisolon puls, prednison given dose 2 mg / kgbb / day and then lowered slowly. Siklofosfamid infusion given every month for six months with the dosage increased to 750-1000 mg/m2 LPB. After giving six times per month, puls siklofosfamid given every 3 months. This regimen is given in the codes of conduct lupus erythematosus Infantile systemic.

b. Metilprednisolon 30 mg / kgbb / dose given for 3 consecutive days followed by a dose of 0.5 siklofosfamid puls g/m2 LPB / dose once a month for 6 months. Prednison 2 mg / kgbb given every other day.

c. Puls cyclophosphamide at a dose of 500 mg LPB-750 mg/m2 given every month to 6 months; dose is increased to 1 g/m2 LPB for leukocytes> 3.000/mm3. Then given high doses of corticosteroids such as methylprednisolone iv Puls 1 g per day for 3 days or prednisone daily intervals; next dose lowered slowly. Patients received hydration for 24 hours before and after cyclophosphamide therapy. In addition to cyclophosphamide Puls, Puls one gives methylprednisolone with oral cyclophosphamide or chlorambucil. Puls methylprednisolone administered at a dose of 30 mg / kg / day for 3 consecutive days followed by prednisone 45 mg/m2 LPB / day and lowered slowly for 3 months, cyclophosphamide 2 mg / kg / day for 2 months, and dipiridamol 5 mg / kg / day for 6 months. Moroni et al. (1998) provide three times Puls methylprednisolone followed by oral prednisone 0.5 mg / kg / day at month 1,3, and 5 and chlorambucil 0.2 mg / kg / day in 2, 4, and 6. This regimen is given for the governance of lupus nephritis.

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