Long-Term Follow up of Type IV SLE Nephritis (without renal failure) Treated by Pulse Cyclophosphamide.

Abstract: Results of PCP are well known in lupus nephritis. We present here it’s outcome in patients with WHO type IV lupus nephritis, treated before the occurrence of renal failure. Patients having a follow up of more than 36 months were selected for this study. 29 patients fulfilled the selection criteria. Proteinuria, hematuria, leucocyturia, cast, BUN, creatinine and blood pressure were measured before PCP and after each one. The first and the last measurements 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 0.5 mg/kg/daily. PCP was repeated once per month. Upon the achievement of a satisfactory improvement PCP was delayed to 2 and then to 3 months. Prednosolone was tapered gradually. Results: The mean follow up time was 53 months. The mean PCP per patient was 10. The 24 h. proteoinuria became normal in 83% of patients and improved in others (mean before 1908 mg, mean after 85 mg, t= 4.812, p<0.001). Hematuria disappeared in 89%, improved in 5.5% and worsened in 5.5% (mean before 22.4, mean after 3.3 RBC/ microscopic field, t=5.824, p<0.001). Casts disappeared in 93% and stabilized in 7% (mean before 3.7, mean after 0.1 cast/microscopic field, t=2.937, p<0.01). No patient developed a renal failure.