CYCLOPHOSPHAMIDE THERAPY FOR LUPUS NEPHRITIS - POOR RENAL SURVIVAL INBLACK-AMERICANS

Intravenous cyclophosphamide is widely used to treat severe lupus neph ritis. Yet interpretation of the literature is limited by the small nu mber of patients evaluated with varied renal histology. We analyzed th e renal outcome of cyclophosphamide therapy for diffuse proliferative lupus glomerulonephritis in a cohort of 89 patients from the Glomerula r Disease Collaborative Network. Statistical analysis included Wilcoxo n rank sum tests or continuity adjusted chi-square for comparisons bet ween groups. Kaplan-Meier survival function estimates were calculated for renal survival curves. Cox's proportional hazards models were empl oyed for multivariate evaluation. The renal survival rate declined yea rly from 89%, to 86%, 81%, 75%, and 71% at year 5. Renal survival was significantly worse in blacks compared with white patients. Among whit e patients 95% retained renal function at year 5 whereas black patient s showed a progressive yearly decline from 85% at year 1, to 79%, 72%, 62%, and 58% at year 5. Racial differences in renal outcome were inde pendent of age, duration of lupus, history of hypertension, hypertensi on control during therapy, and activity or chronicity indices on renal biopsy. The factors that predispose black patients to more aggressive and treatment-resistant lupus nephritis are not apparent.