Lupus nephritis outcomes

Glomerulonephritis is one of the most serious complications of systemic lupus erythematosus (SLE) and accounts for much of the morbidity and mortality of patients afflicted with the disease. The renal manifestations of lupus nephritis are variable and encompass a wide spectrum of histopathologic lesions. ° ° The underlying histopathology is associated with different prognoses and responses to therapy, which cannot be predicted solely based on clinical manifestations. A renal biopsy is therefore required to assess the severity of the disease and to predict the short-term and long-term outcomes associated with therapy. Drugs, such as hydralazine and procainamide, are known to precipitate a lupus syndrome however, they are unlikely to cause disease that affects the kidney. 

Illei GG, Austin HA, Crane M, et al. Combination therapy with pulse cyclophosphamide plus pulse methylprednisolone improves long-term renal outcome without adding toxicity in patients with lupus nephritis. Ann Intern Med. 2001 135 248-257. 

Evidence supporting the use of cyclophosphamide in lupus nephritis has been collected over the last several decades. Controlled clinical trials have shown that cyclophosphamide improved the longterm outcomes in lupus nephritis. " Based on controlled trials, combination prednisone and cyclophosphamide has become standard treatment for focal and diffuse proliferative lupus nephritis (WHO class III/IV) and is superior to prednisone alone. There are no studies examining cyclophosphamide in earlier stages of nephritis (WHO class II/III), and therefore, corticosteroids remain the treatment of... 

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