Thanks in advance for the answers. Recently, I have a 17 year-old girl who has clinical SLE. She has been treated in a children’s hospital for lupus nephritis with oral cyclophosphamide for 84 days, and despite this, her kidney function has deteriorated with serum creatinine 5 mg/dL and has been referred for hemodialysis twice weekly for 2 months now. Because of her age, she is now being referred for further care as adult case. Her serum creatinine 1 month ago before the scheduled hemodialysis was 6.11 mg/dL and proteninuria 3+ with normal kidneys size, but loss of cortico-medullary differenciation. Her urine output was about 250cc/day. BP 120/80 mm Hg. After 1 month of swiching to prednisolone 40 mg/day with MMF 1.5 g/day (along with furosemide, EPO and iron), her urine output seems increasing to 500 cc/day, but serum creatinine after hemodialysis is 3.71 mg/dL and up to 5.5 mg/dL the next day. Clinically she feels a bit better and her ANC moves from 85 to 127.

My questions are:
1.) Would the regimen work? What are clinical signs and lab to follow?
2.) When should I switch to another therapy? and what is that another regimen?
3.) Could she be off from hemodialysis in the future and how/when to do it?

Thanks again for the answers. Bunse Leang