Efficacy and toxicity of treatments for nephritis in a series of consecutive lupus patients.
OBJECTIVE
To study efficacy and toxicity of treatments for nephritis in a series of consecutive lupus patients.


METHODS
The case records of 40 patients with lupus nephritis followed up in a single center between 1992 and 2011 (median duration = 8.37 years) were retrieved to determine efficacy and toxicity of the treatments. Patients with class III/IV/V lupus nephritis were included.


RESULTS
Sustained responses were 21/40 (52.5%) at six months, 33/40 (82.5%) at 18 months and 30/40 (75.0%) at 36 months. Three deaths were observed after 18, 104 and 164 months of follow-up respectively, with one possibly associated with immunosuppression. Kidney survival was 100% at 18 months and 97.7% at 36 months. Kaplan-Meier's survival algorithm estimated a mean overall survival of 236.05 ± 11.56 months and a kidney survival of 240.77 ± 11.07 months. Kidney and overall survival were not significantly different among patients with different nephritis classes. Complications occurred in 12/40 (30.0%). Amenorrhea occurred in 20.7% of patients and was associated with higher cumulative doses of cyclophosphamide. Patients who achieved remission at 36 months or later had lower levels of proteinuria at 6 months (mean ± SD = 0.93 ± 0.97 g/24 h versus 2.60 ± 2.11 g/24 h, p = 0.002) than non-responder patients.


CONCLUSIONS
The data demonstrate that in the overall Caucasian population with lupus nephritis the combination of available therapeutic tools is effective and relatively well tolerated.
Unit of Medicine & Clinical Immunology, Department of Medicine , 20132 Milano , Italy .
Enrica P
EP
Bozzolo
Giuseppe A
GA
Ramirez
Giovanna
G
Bonavida
Chiara
C
Lanzani
Raffaella
R
Scotti
Giacomo
G
Dell'antonio
Elena
E
Baldissera
Valentina
V
Canti
Angelo A
AA
Manfredi
Patrizia
P
Rovere-Querini
Maria Grazia
MG
Sabbadini
D000328:Adult; D015415:Biomarkers; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008181:Lupus Nephritis / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D015415:Biomarkers; D007166:Immunosuppressive Agents