Evolution of severe lupus nephritis treated with parenteral cyclophosphamide and oral steroids

The treatment of lupus nephritis is still debated although in the most seve re forms of renal disease the association of pap-enteral cyclophosphamide a nd oral steroids seems to be a good therapeutical choice that allows to con trol the disease and prevents the progression to chronic renal failure. The objectives of this study are to describe the evolution of 25 patients with severe lupus nephritis who were treated with parenteral cyclophosphamide a nd oral steroids, report secondary effects of this treatment and describe o ther therapies used thereafter. During the follow-up we studied the evoluti on of the levels of leukocytes, hemoglobin, hematocrit, urea, creatinine se rum albumin, complement antinuclear and anti-DNA antibodies and proteinuria . The evolution of blood pressure was also studied. A satisfactory response to treatment was obtained in 77% of the patients. Significant decrease of proteinuria (p < 0.005) associated to an increase of serum albumine values (p < 0.005) after the sixth month of treatment and an improvement of the im munological parameters were found. Better control of blood pressure was als o achieved. At the beginning of the study 4 patients has a moderate renal f ailure, 2 new cases appeared during the follow-up. Leucopenia and urinary i nfections were the most frequent side effects although the amount of seriou s events was scant Eight patients disrupted treatment before 12 doses were given, in 5 of them due to infections. After finishing cyclophosphamide, lo w-dose steroids alone or combined with other immunosuppressive drugs were c ontinued. Two patients developped end- stage renal disease and begun hemodi alysis. We conclude that the combination of parenteral cyclophosphamide and oral steroids is a good therapeutic alternative in severe forms of lupus n ephritis with good short-term outcome and low number of adverse events. How ever, prospective, long-term studies with a greater number of patients are necessary in order to establish progaqstic and therapeutic conclusions.