NEW-YORK-UNIVERSITY HOSPITAL FOR JOINT DISEASES EXPERIENCE WITH INTRAVENOUS CYCLOPHOSPHAMIDE TREATMENT - EFFICACY IN STEROID UNRESPONSIVE LUPUS NEPHRITIS

The medical records of patients receiving cyclophosphamide for lupus n ephritis between 1987 and 1993 at the New York University/Hospital for Joint Diseases Lupus Study Group Institutions were retrospectively re viewed. We identified 45 patients (38 female, seven male) who received a mean of 9 +/- 1 (range 2-23) pulses of intravenous cyclophosphamide for diffuse proliferative glomerulonephritis (n = 28), focal prolifer ative glomerulonephritis (n = 7), membranous nephropathy (n = 5), mesa ngial nephropathy with sclerosis (n = 1) or nephritis without biopsy ( n = 4). Forty-two of the 45 patients received cyclophosphamide after f ailing steroid therapy. During a follow-up period of 52 +/- 3 months, nine patients progressed to end-stage renal disease (ESRD) with three additional patients experiencing a doubling of the creatinine and two patients persistent nephrotic range proteinuria. There were no deaths directly attributable to cyclophosphamide and no patients developed he morrhagic cystitis or malignancy. Ten of 37 women had ceased menstruat ing prior to cyclophosphamide therapy. Treatment-associated amenorrhea occurred in only three patients all over 27 years of age. Intermitten t intravenous cyclophosphamide therapy of lupus nephritis is well tole rated and usually effective in maintaining renal function in patients unresponsive to steroids although, in our experience, 20% of patients developed ESRD and a total of 14 of 45 (30%) patients had unsatisfacto ry outcomes.