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Abstract Systemic lupus erythematosus (SLE) is an autoimmune disease which predomenantly affects females. It involves multiple organs and may present as articular and mucocutaneous involvement, renal disease ,hematological and central nervous system disease (Cervera et al.,1993) Renal involvement is present in 40%-80% of pediatric lupus patients (Bagi et al., 1996). The most commonly used scheme for classifying lupus nephritis has been that of the WHO. Early renal involvement is often asymptomatic. Furthermore, considerable loss of renal function can occur without notable clinical manifestation or significant change in serum creatinine (Esdail,2003). Nephritis is known as the most serious complication of SLE and the strongest predictor of poor renal outcome (Huong et al., 1999). Although the survival of SLE patients has improved in the past 50 years (Merrell and Shulman,1995),recent studies show that patients with lupus nephritis (LN) remain at substantial risk of developing end-stage renal disease (ESRD),with estimates varying from 10% to 70% after 5 years (Mac Gown et al.,2002). Modern immunosuppressive therapies are effective in controlling disease activity and LN. Renal flares are less common after cytotoxic drug therapy than after corticosteroid therapy (Illei et al., 2002). The recommended regimen for LN was monthly pulse intravenous cyclophosphamide (CY) for 6 months followed by quarterly pulse treatment for 2 years (Mac Gowan et al., 2002). However renal flares are still common (up to 45%) in patients with severe proliferative LN treated with pulse immunosuppressive therapy (Wang et al.,2004). |