Retrospective analysis of outcome in a cohort of patients with lupus nephritis treated between 1977 and 1999

OBJECTIVE: To review the development, histological type and outcome of a cohort of patients with lupus nephritis who were managed and followed up by the specialist Bloomsbury Rheumatology Unit between 1977 and 1999. PATIENTS AND METHODS: Seventy-eight of the 280 (28%) patients with systemic lupus erythematosus (SLE) developed nephritis. Occurrence of end stage renal disease (ESRD) according to World Health Organization (WHO) class was analysed, and patients were subdivided according to whether treatment included at least six pulses of intravenous (i.v.) cyclophosphamide (CYC) once a month. RESULTS: For patients with WHO class III nephritis, three out of five treated with i.v. CYC developed ESRD compared with none out of 10 not treated with i.v. CYC (P < 0.02). There was no significant difference between these subgroups in terms of a variety of parameters with good prognostic value, except anti-dsDNA titre at time of biopsy (which was greater in the former). For patients with WHO class IV nephritis, three out of 16 treated with i.v. CYC developed ESRD, compared with five out of 20 not treated with i.v. CYC (no significant difference). CONCLUSION: These data suggest that there may be a subgroup of patients with lupus nephritis (WHO class III) whose long-term outcome is not adversely affected by the omission of i.v. CYC.