TREATMENT OF LUPUS NEPHRITIS WITH PULSE C GCLOPHOSPHAMIDE

The treatment of severe lupus nephritis remains problematic We have an alysed retrospectively 17 patients with corticoresistant lupus nephrit is treated with pulse cyclophosphamide. Single monthly doses (500 mg/m 2) were given by intravenous infusion with a mean of 10.4 infusions pe r patient (3 to 18). A comparison of parameters at entry and at the en d of the treatment revealed an improvement in proteinuria (4.8 vs 1.9g /24 h;p < 0.013),whereras mean serum creatinine level and SLAM (System ic Lupus Activity Measure) remained stable. The results,were identical at follow,o up (mean: 14.5 months). Most of the therapeutic effect wa s achieved as soon as the 6th pulse. Further treatment was beneficial for four patients only. None of the studied parameters (serum creatini ne level, renal biopsy, SLAM) was predictive of a response to an exten ded course of pulse cyclophosphamide. The infusions were definitively stopped in one patient and delayed in two others because of serious ad verse effects. The data indicate that, in mean term, monthly intraveno us cyclophosphamide was associated with a substantial amelioration of 24 hours urinary protein level. An amelioration of the renal function was however, uncommon.