Therapy with pulse methylprednisolone and short course pulse cyclophosphamide for diffuse proliferative glomerulonephritis

Abstract

The incidence of renal flares and the long-term outcome in a group of 33 systemic lupus erythematosus (SLE) patients with diffuse proliferative glomerulonephritis (DPGN) treated with pulse steroids and a short course of pulse cyclophosphamide (CYC) are evaluated. Fifteen patients (45%) experienced a flare of renal disease at some time after the discontinuation of the immunosuppressive (IS) therapy; among these half (24%) were 'early' flares occurring shortly after the discontinuation of therapy, and the other half (21%) were 'late' flares occurring more than 2 y after the discontinuation of the treatment. Nine patients (27%) showed a poor renal outcome at the end of follow-up. On multiple regression analysis, a younger age and a high activity index (AI) on renal histology were found to be correlated with the occurrence of renal flares. Our results suggest that the combination of pulse steroids with a short course of pulse CYC (six to nine pulses) is effective in both controlling disease activity and in preventing the occurrence of renal flares in DPGN. However, short term IS therapy might not be sufficient to maintain disease control in younger patients with active lesions on renal histology. Such patients might be candidates to receive more prolonged IS treatment.

Mycophenolate mofetil versus azathioprine as maintenance therapy for lupus nephritis: A meta‐analysis

“…Fifth, we did not detect evidence of publication bias, because the use of statistical tests to detect such bias with so few available studies is unhelpful . Maintenance treatment should only be completely withdrawn in patients treated for at least 5 years who have maintained remission for at least 2 years . Therefore, further large scale RCT studies with long‐term follow‐up are warranted.…”

“…29 Maintenance treatment should only be completely with-drawn in patients treated for at least 5 years who have maintained remission for at least 2 years. [30][31][32] Therefore, further large scale RCT studies with long-term follow-up are warranted.…”

Outcome and prognostic indicators of diffuse proliferative lupus glomerulonephritis treated with sequential oral cyclophosphamide and azathioprine

“…Table 5 summarizes the rates of remission, relapse, and doubling of the serum creatinine level in lupus nephritis patients treated with CYC that have been reported in major international series (10, 13, 23, 25, 36–41). Direct comparisons among these studies are difficult because of the discrepancies in the proportion of patients with DPGN (World Health Organization class IV) who were included, the severity of renal disease at biopsy, the criteria for remission/relapse, the ethnicity of the patients, and the great variation in treatment protocols in terms of steroid dosage, route and duration of CYC, and the use of plasmapheresis.…”

“…The rate of relapse of nephritis after CYC treatment of proliferative lupus nephritis ranges from 10% to 66% in various studies (13, 25, 36, 38, 39, 41). The wide range of relapse rates is, again, probably related to the differences in the characteristics of the study patients, the treatment regimens, the definition of relapse, and the duration of observation.…”

Value of a Complete or Partial Remission in Severe Lupus Nephritis

“…When evaluated, the attainment of a PR ranges from 10 to 50%, and, in this case, the definitions applied are even more variable (8,9,33,34). Some studies merely required proteinuria to be "fixed" or "improved" (9), whereas others required a 50% reduction in proteinuria (35), a 50% reduction in proteinuria to a level of proteinuria of 1 to Ͻ3 g/d (34,36), a 50% reduction in proteinuria to a level of 0.3 to Ͻ3 g/d (8,33,37), or a reduction in proteinuria to Յ1 g/d (29). Renal function requirements, although not always specified, include remaining stable or improved, Ն50% improvement from baseline, or lack of worsening from baseline of Յ25 to 50%.…”