Volume 19, Number 2 (8-2005)                   Med J Islam Repub Iran 2005 | Back to browse issues page


XML Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

REZAIE-YAZDI Z, FORGHANIZADEH J, REZAIE J, SALEHIAN P, MANSOURI TORGHABEH H. COMBINATION THERAPY WITH PULSE CYCLOPHOSPHAMIDE PLUS CORTICOSTEROIDS IMPROVES RENAL OUTCOME IN PATIENTS WITH LUPUS NEPHRITIS. Med J Islam Repub Iran. 2005; 19 (2) :109-117
URL: http://mjiri.iums.ac.ir/article-1-433-en.html

-\ss istant pm!'csso r of Rile un talology c;hac·m hospital. MashhadL'ni1 ersit1· o!' Medical Science. Mashhad. Iran. , rezaieyazdi@mums.ac.ir
Abstract:   (2962 Views)

 ABSTRACT

 Background: The prognosis of SLE is int1uenced by the onset of glomerulonephtitis. Clinical ttials in lupus nephritis have demonstrated that cyclophosphamide therapy is the superior regimen in the management oflupus nephritis for preserving renal function.

 Objective: The purpose of this study is to define the outcome of renal function with bolus pu lses of cyclophosphamide and steroid according to our protocol and also to determine an appropriate pattern of treatment of lupus nephritis.

 Methods: In this open-label clinical triaL to evaluate the results, the short-term prognosis and the rate of complications of an immunosuppressive regimen with corticosteroids and cyclophosphamide, twenty-five patients with biopsy-proven lupus nephritis were studied. Treatment was structured in 4 phases: I) Induction with bolus methylprednisolone and cyclophosphamide. 2) Maintenance with oral prednisolone for 4 weeks and monthly cyclophosphamide pulses for 6 months. 3) Tapeting with reduction of prednisolone by 10% each month and continuing cyclophosphamide every other month till one year and for the second year every 3 months. 4) Discontinuation with oral prednisolone slowly tapered to the least effective daily dose and cyclophosphamide discontinued after 2 yr of therapy. We defined primary outcome measures according to these criteria: renal function return to normal limits or become stable, regression of systemic and local inflammatory symptoms. urine protein excretion h1lling below 0.3 gr/ elL or by at least SOo/c. RBC cast disappearance, C3, C4, Hb, and ESR return to notmallimits.

 Result: Twenty-three patients wi th lupus nephritis completed our therapeutic protocol. Renal biopsy was perfonned in 22 cases and indicated type IV in 20 patients (95.2%), and type V in 2 patients. After an average of 4+ 1.95 months 22 patients achieved remission (95.65%) and only one case remained non-responsive. She became pregnant in her fourth month of therapy. Significant statistical differences were achieved between creatinine, proteinuria, hematuria, leukocyturia, urinary cast, C3, C4, ESR, and Hb before and after therapy (p<0.05). Plasma creatinine fell from 1 .44+0.95 mg/dL to 0.97+0. 78 (p<0.004). Proteinuria fell from 1879.78+ 1854.46 to 408.34+572.92 mg/24h (p

 Conclusion: Intensive immunosuppression with steroid and cyclophosphamide provides excellent results with an acceptable rate of complications in the treatment of lupus nephritis.

Full-Text [PDF 2003 kb]   (972 Downloads)    

Send email to the article author