TREATMENT OF DIFFUSE PROLIFERATIVE LUPUS NEPHRITIS - AN INDIAN EXPERIENCE

Background. Immunosuppressive therapy has improved the prognosis in lu pus nephritis. However, infectious complications may contribute to mor bidity. There is also debate on the best form of therapy. We, therefor e, compared the results of two different forms of therapy. Method. Twe nty-nine patients diagnosed to have diffuse proliferative lupus nephri tis were followed up over 54 months. The treatment consisted of azathi oprine (1.5 mg/kg/day) or pulse intravenous cyclophosphamide (500 mg/m (2) body surface area monthly) along with prednisolone (2 mg/kg on alt ernate days). Results. Seventeen patients received azathioprine (group A) and 12 received cyclophosphamide (group B). The mean (SD) follow u p in groups A and B were 54.35 (33.6) and 52 (35.8) months, respective ly. Apart from the higher number of males in group B, both groups were comparable for age, presence of hypertension, renal function, 24-hour urinary protein excretion and composite scores for histological activ ity and chronicity indices (p>0.05). The renal survival estimated by t he Kaplan-Meier method was similar in both groups (p>0.05). Four patie nts had renal failure requiring replacement therapy in group A and 3 i n group B. Major infective episodes were more common in group B than i n group A (p=0.03). Conclusion. Azathioprine was as effective as pulse intravenous cyclophosphamide in preserving renal functions up to 54 m onths. Major infective episodes were more common with pulse intravenou s cyclophosphamide.