[Appraisal of renal failure reversing therapies in lupus nephritis].
OBJECTIVE
This study aimed to explore the therapies of reversing renal failure in lupus nephritis.


METHODS
The research strategy was a retrospective cohort study. 173 patients were included in the study. All of them were consecutive in-patients of newly diagnosed renal failure (serum creatinine > 180 micromol/L) with lupus nephritis from 1991 to 1999 in the university hospital. The research factors included steroids, cyclophosphamide and cyclosporin. Steroids were divided to oral prednisone, intravenous dexamethasone and intravenous methylprednisolone pulse; cyclophosphamide dose intensity was divided into three grades: none, low dose (average dose <or=0.25 g/m(2) body surface area per week) and high dose (average dose > 0.25 g/m(2) body surface area per week). 51 demographic, clinical and laboratory data were included in the study as possible confounding factors. The study end-point was recovery of renal function that was defined as a level of serum creatinine <or= 116 micromol/L in the azotemia patients or a 50% reduction of serum creatinine and discontinuation of dialysis in the uremic patients. The improvement had to be maintained for at least three months. Collection of the study factors and outcome variable was conducted by two separate, blinded groups of clinical specialists with two structured abstracting forms.


RESULTS
The number of complete following up patients was 142 (82.1%). After over 6 months of following up, 93 cases (65.5%) recovered their renal function and 17 cases (12.0%) died. In COX proportional hazard regression model, cyclophosphamide therapy was significantly associated with the recovery of renal function. The adjusted hazard ratio (HR) to recovery of renal function was 4.41, 95% CI = 1.03 - 18.94 in low dose; and the HR was 13.29, 95% CI = 3.11 - 56.82 in high dose cyclophosphamide therapy. The gender, duration of renal dysfunction, small renal size, severe anemia and serum creatinine were also significantly associated with renal function recovery. Cyclophosphamide therapy was not significantly associated with death. The variables associated with death were low level of serum albumin and edema.


CONCLUSIONS
Cyclophosphamide pulse was an efficient therapy in reversing renal failure of lupus nephritis, especially in the patients with short duration of renal failure, non-small in renal size, and non-severe anemia.
Yang
X
X
Department of Rheumatology & Clinical Immunology, The First Affiliated Hospital, Sun Yat-sen University of Medical Sciences, Guangzhou 510080, China.
Liang
L
L
Zhan
Z
Z
Ye
Y
Y
Liu
Y
Y
Yu
X
X
Chen
W
W
Yin
P
P
D000284:Administration, Oral; D015331:Cohort Studies; D003520:Cyclophosphamide / Q000008:administration & dosage*; D016572:Cyclosporine / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007275:Injections, Intravenous; D008181:Lupus Nephritis / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D011241:Prednisone / Q000008:administration & dosage; D016016:Proportional Hazards Models; D020127:Recovery of Function; D051437:Renal Insufficiency / Q000188:drug therapy* / Q000209:etiology; D012189:Retrospective Studies
D007166:Immunosuppressive Agents; D003907:Dexamethasone; D016572:Cyclosporine; D003520:Cyclophosphamide; D011241:Prednisone; D008775:Methylprednisolone