ABSTRACT
The authors analysed outcome retrospectively in relation to treatment and disease stage in patients with systemic lupus erythematosus and glomerulonephritis; and compared these with similar patients referred to us during 1969 - 78; and other published series from the same period. Eighty two patients with lupus nephritis were referred during 1979 - 89. Of these; 73 were followed up for a mean of 58.1 (SD 34.5) months. The histological pattern in renal biopsies was WHO Class IV (diffuse proliferative glomerulonephritis) in 59 per cent of patients. In the acute phase 43 patients received intravenous nethyl-prednisolone IG daily; for three days; in 25 accompanied by daily 4 liter plasma exchanges on 5 to 10 days. Twelve patients received induction therapy using oral cyclophosphamide during the acute phase; for 8 - 12 weeks only. Maintenance therapy was with oral prednisolone in all patients; accompanied by azathioprine in 84 per cent of cases. Long term cyclophosphamide was never used; neither intravenously nor orally. At 10 years actuarially calculated patient survival was 87 per cent; and survival of renal function 86 per cent; compared with 57 per cent and 65 per cent respectively in 1970 - 78 (p less than 0.01). Survival was no different in patients with renal biopsies classified into the various WHO classes. In patients with Class IV biopsies; survival in those treated with prednisolone and azathioprine only was the same as that in those given intravenous methylprednisolone and/or plasma exchange as well. However; patients treated with methylprednisolone or plasma exchange tended to have more severe disease. At last followup; 24/82 patients were in complete remission; 23 had normal plasma creatinine concentrations but abnormal urine; ie proteinuria; heaematuria; or both; 16 had abnormal urine and elevated plasma creatinine concentrations; and 9 had started renal replacement therapy. Eight patients had died. The survival of patients with lupus nephritis has improved in the past decade in patients with comparable severity of disease; and renal failure is no longer the principle cause of death. Results of maintenance treatment using azathioprine as adjunct to oral prednisolone in patients with severe nephritis are as good as those in series published elsewhere describing regular intravenous cyclophosphamide. No clear advantage was evident from the additional use of intravenous methylprednisolone and/or plasma exchange in the acute phase; in patients with WHO Class IV severe diffuse proliferative glomerulonephritis