Pulse cyclophosphamide in SLE nephritis, analysis of 84 cases.


Abstract: Pulse cyclophosphamide (PCP) is a well established method for the treatment of lupus nephritis. PCP seems to produce better results with lesser side effects, than oral cytotoxic drugs. We presenthere, our experience with this method, in 84 patients. All patients had a WHO type IV histological lesion, on light microscopy, Proteinuria, hematuria, leucocyturia, casts, BUN, creatinine, and blood pressure were measured before starting PCP and after each one. The first and the last measurement were compared to each other by the Student paired t test. Cyclophosphamide was given as 1000 mg per m2 of body surface. Prednisolone was administered, per os, as 1/2 mg per kilogram of body weight. PCP was repeated once per month: When a satisfactory result was obtained, the gap between pulses was increased to 2 and then to 3 months and prednisolone was gradually tapered. RESULTS: The mean follow up time was 20.1 months. The mean pulse per patient was 8.4 pulses. Proteinuria improved. in 87% of patients. The mean proteinuria decreased from 2398 to 843 mg per 24 hour (t=5.303, p<0.000001).Hematuria improved in 84% of patients. The mean hematuria decreased from 17.2 to 4.5 red blood cells per microscopic field (t=6.762, p<0.000001). Leucocyturia improved in 67% of patients. The mean leucocyturia decreased from 13.8 to 6.8 white blood cells per microscopic field(t=3.877, p=0.0003). Casts improved in 89% of patients. The mean number of casts decreased from 3.6 to 0.3 per microscopic field (t=6.396, p<0.000001). Creatinine improved in 75% of patients. The mean serum creatinine (normal range up to 1.2) decreased from 1.7 to 1.1(t=3.293, p=0.004). The changes in abnormal BUN and blood pressure were not statistically significant. Side effects were minor: Nausea and vomiting after PCP, and moderate hair loss in some patients.