title: Prednisone monotherapy induced remission in a group of patients with membranous lupus nephritis.
abstract: The treatment of membranous lupus nephritis (MLN) is still controversial in the literature. We conducted a retrospective analysis of patients in two medical centers of São Paulo-Brazil in order to evaluate the clinical response in patients submitted to either a regimen with prednisone alone or to a double immunosuppressive regimen (prednisone plus cyclophosphamide or prednisone plus azathioprine).
  
  
  METHODS
  MLN female patients were enrolled in this retrospective study conducted from February 1999 to June 2007. Data were collected from the patients' medical charts. Race distribution was similar in both groups: Caucasian (72.3%) and Afro-Latin-American (27.7%). The prednisone regimen consisted of 1 mg/kg/day for 8 weeks and tapering until 0.1 mg/kg/day (n = 29). The double immunosuppressive treatment consisted of the same doses of prednisone plus monthly intravenous cyclophosphamide or azathioprine for 6 months (n = 24). Criteria for remission (complete and partial) and renal function loss as well as flare criteria followed those used in the literature.
  
  
  RESULTS
  There was no difference between the prednisone group and the double immunosuppressive group regarding age (33.2 ± 9.4 vs. 29.1 ± 9.1 y), estimated GFR (76.5 ± 26.6 vs. 74.1 ± 39.6 ml/min/1.73 m2), serum albumin (2.8 ± 0.7 vs. 2.6 ± 0.3 g/dl), positive ANA (87.5 vs. 90.0%), positive anti- dsDNA (47.6 vs. 44.0%), renal SLEDAI indices (6.6 ± 2.6 vs. 7.0 ± 3.1), follow-up time (71 ± 46 vs. 62 ± 45 months), as well as proteinuria (3.1 ± 1.9 vs. 4.8 ± 2.4 g/day) and number of non-nephrotic patients (6 in the prednisone group vs. 3 in the double immunosuppressive group). The prednisone group presented higher C3 values (85.2 ± 31.5 vs. 62.3 ± 41.6 U/ml, p = 0.04). Clinical and laboratory characteristics at 6 months and at last follow-up did not reveal any differences between treatment regimens. Renal survival after an 8-year follow-up did not differ in both groups (prednisone group 86.2% vs. double immunosuppressive group 75%), and patients in both groups showed a high rate of renal flares (prednisone group 51.7% vs. double immunosuppressive group 62.5%). Univariate analysis showed that only patient age predicted flares (r = -0.048, p = 0.04). Borderline significance was obtained for proteinuria analysis (p = 0.07). Adverse effects did not differ between the groups.
  
  
  CONCLUSIONS
  A regimen of corticosteroids in MLN induced a high remission rate after 6 months. Both treatment regimens showed a high flare rate and age was the only predictive parameter (r = -0.048, p = 0.04). Renal survival after 8 years did not differ between the groups.
authors: Division of Nephrology, Department of Internal Medicine, University of São Paulo, Brazil. cristianebitencourt@uol.com.br
authors: C
authors: C
authors: Bitencourt Dias
authors: C C
authors: CC
authors: Pinheiro
authors: P
authors: P
authors: Malafronte
authors: S
authors: S
authors: Titan
authors: G
authors: G
authors: Alves de Brito
authors: J
authors: J
authors: Gera Abrão
authors: V
authors: V
authors: Dos Santos Silva
authors: R
authors: R
authors: Toledo Barros
authors: V
authors: V
authors: Woronik
mesh_terms: D000328:Adult; D001379:Azathioprine / Q000008:administration & dosage; D003404:Creatinine / Q000097:blood; D003520:Cyclophosphamide / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D005938:Glucocorticoids / Q000008:administration & dosage; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008181:Lupus Nephritis / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D011241:Prednisone / Q000008:administration & dosage*; D011507:Proteinuria; D012074:Remission Induction; D012709:Serum Albumin / Q000032:analysis
chemical_list: D005938:Glucocorticoids; D006454:Hemoglobins; D007166:Immunosuppressive Agents; D012709:Serum Albumin; D003520:Cyclophosphamide; D003404:Creatinine; D001379:Azathioprine; D011241:Prednisone