Objective: To evaluate the treatment of proliferative lupus nephritis with methylprednisolone pulse therapy and oral azathioprine.
Patients and methods: Eighteen patients with severe proliferative lupus nephritis (Class III, IV or Vd according to criteria of the World Health Organization) were treated with intravenous methylprednisolone (MP) pulse therapy in combination with a low oral maintenance dose of prednisone (20 mg) and azathioprine (2 mg/kg). Thirteen patients (Group I) had a recent onset of clinical manifestations of nephritis at referral (mean and median 4 months). Five patients (Group II) had clinical signs of nephritis for a long time (median 4 years, mean 5 years) and were referred because of progressive renal failure. The mean plasma creatinine in Group I was 109 mumol/l with a mean GFR of 58 ml/min, the mean plasma creatinine in Group II was 284 mumol/l with a mean GFR of 12 ml/min. Renal histology in Group II was characterized by severe chronic damage (chronicity index 8-10).
Results: Short-term and long-term effects of treatment were excellent in Group I. The mean plasma creatinine was 68 mumol/l with a mean GFR of 102 ml/min at a mean follow-up of 7 years, median 4 years (range 1-15 years). All patients in Group II needed renal replacement therapy after a mean follow-up of 2.6 years, median 2 years (range 0-8 years). Major side-effects of treatment were only seen twice.
Conclusion: Methylprednisolone pulse therapy in combination with low oral maintenance doses of prednisone and oral azathioprine is an effective and safe treatment for patients with severe active proliferative lupus nephritis. In patients with extensive irreversible lesions, this treatment has no or only a temporary effect.