IMMUNOSUPPRESSIVE THERAPY IN LUPUS NEPHRITIS

Objective: To evaluate the outcomes and side effects of immunosuppress ive therapy in patients with lupus nephritis. Patients and methods: Th irty-nine patients with lupus nephritis assessed between 1988 and 1993 with a median follow-up of 46 months (range 12-60 months) were studie d. Lupus nephritis was biopsy-proven in 37 patients. Patients received a median of 3 (500 mg) weekly pulses of intravenous cyclophosphamide followed either by azathioprine (n = 32) or oral cyclophosphamide (n = 7). All patients received oral prednisolone. The time from biopsy to renal insufficiency, defined by doubled serum creatinine and/or end st age renal failure, was used to assess outcome. Results: There were sig nificant improvements in the median changes of all major laboratory pa rameters. Serum creatinine levels did not change significantly. The pr ednisolone dose was significantly reduced during the follow-up period. Outcome: renal function remained stable in 26 (67%) and deteriorated despite therapy in 13 (33%) patients. 6/13 (42%) of these patients had impaired renal function at the time of biopsy. The adverse effects of intravenous cyclophosphamide seen were Herpes zoster (1), transient l eucopenia (2), rash (1) and fatal septicaemia (1); of azathioprine uri nary infections (3), leucopenia (5), rash (1) and increased liver enzy mes (1); and of oral cyclophosphamide ovarian failure (4), Herpes zost er (3), haemorrhagic cystitis (1), and fatal septicaemia (1). Conclusi ons: Therapy with weekly low doses intravenous pulse cyclophosphamide to induce remission, followed by azathioprine appears to be useful in preserving renal function in patients with diffuse proliferative lupus nephritis. In comparison to ther studies, the reduced incidence of ov arian failure using this regimen was striking.