Successful Treatment with Mycophenolate Mofetil and Tacrolim
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Juvenile onset lupus nephritis (LN) often has very active and severe disease presentation. Several studies have shown that mycophenolate mofetil (MMF) is at least as effective as intravenous cyclophosphamide (IVCY) for active LN. Despite aggressive induction therapy, up to 20% of patients with LN are resistant to initial therapy and up to 44% suffer a renal relapse. However, there is no consensus on an appropriate therapeutic regimen for refractory LN. Tacrolimus (Tac) is an immunosuppressive macrolide of the calcineurin inhibitors. Recently, the addition of Tac to treatment with MMF has been reported to be useful in refractory LN. We report a 13-year-old girl with recurrent LN (nephrotic syndrome and acute renal dysfunction), who was not taking her medications....

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4346693/
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