TREATMENT OF PROLIFERATIVE LUPUS NEPHRITIS WITH METHYLPREDNISOLONE PULSE THERAPY AND ORAL AZATHIOPRINE

Objective: To evaluate the treatment of proliferative lupus nephritis with methylprednisolone pulse therapy and oral azathioprine. Patients and methods: Eighteen patients with severe proliferative lupus nephrit is (Class III, IV or Vd according to criteria of the World Health Orga nization) were treated with intravenous methylprednisolone (MP) pulse therapy in combination with a low oral maintenance dose of prednisone (20 mg) and azathioprine (2 mg/kg). Thirteen patients (Group I) had a recent onset of clinical manifestations of nephritis at referral (mean and median 4 months). Five patients (Group II) had clinical signs of nephritis for a long time (median 4 years, mean 5 years) and were refe rred because of progressive renal failure. The mean plasma creatinine in Group I was 109 mu mol/l with a mean GFR of 58 ml/min, the mean pla sma creatinine in Group II was 284 mu mol/l with a mean GFR of 12 ml/m in. Renal histology in Group II was characterized by severe chronic da mage (chronicity index 8-10). Results: Short-term and long-term effect s of treatment were excellent in Group I. The mean plasma creatinine w as 68 mu mol/l with a mean GFR of 102 ml/min at a mean follow-up of 7 years, median 4 years (range 1-15 years). All patients in Group II nee ded renal replacement therapy after a mean follow-up of 2.6 years, med ian 2 years (range 0-8 years). Major side-effects of treatment were on ly seen twice. Conclusion: Methylprednisolone pulse therapy in combina tion with low oral maintenance doses of prednisone and oral azathiopri ne is an effective and safe treatment for patients with severe active proliferative lupus nephritis. In patients with extensive irreversible lesions, this treatment has no or only a temporary effect.