Long-Term Outcome of Patients with Lupus Nephritis: A Single Center Experience
Keywords:lupus nephritis, cyclophosphamide, mycophenolate mofetil, treatment outcome
Lupus nephritis (LN) is an immune inflammation of kidneys caused by systemic lupus erythematosus (SLE), a chronic inflammatory disease that affects the body’s immune system. Aim of this study was to analyze clinical manifestation and treatment results of patients with LN. Forty one patients with clinical signs of LN were included in the study. Mean age of patients was 31,9±12,1 years in the moment of first diagnosis of LN, with female-male ratio 8:1. Renal disease was pathohistologically (PTH) verified in 53,7% of patients (4 pts with class III, 17 pts with class IV, one pt with class V of lupus nephrites). Patients with high nephrotic proteinuria were treated with pulse dose of methylprednisolone and pulse doses of cyclophosphamide (CYC) in induction therapy. Corticosteroid and CYC were continued according to treatment protocol. The other group of LN patients with lower nephrotic proteinuria was treated with mycophenolate mofetil (MMF) in induction therapy at a dose of 2x1 g/day for six months, and than in maintenance 2x0,5 g/day. The patients with non-nephrotic proteinuria and normal renal function were treated with oral prednisolone 0,75-1 mg/kg/day in a single morning dose, and then gradually reduced to the dose of maintenance. The mean time of patient’s follow-up was 10,9±4,1 years. Partial renal remission was accomplished in 29,2% pts, and complete remission in 60,9% pts for period of 17,2±13,3 months from the beginning of the treatment. Duration of complete renal remission was 30,1±19,1 months. During the period of follow-up, 29,3% pts developed at least one nephritic flare and were treated again. These results confirmed that the aggressive form of lupus nephritis should be treated associating cyclophosphamide with corticosteroids therapeutical regiment. MMF is a new promising immunosuppressive drug for a treatment of this serious disease.