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Abstract
Background Lupus Nephropathy (LN) is an important cause of morbidity and mortality in patients with Systemic Lupus Erythematosus (SLE). The goal of LN treatment is to suppress inflammation and preserve renal structure and function to prevent progression to kidney failure, in addition to minimizing side effects. Currently therapy for severe LN is based on high doses of glococorticoids and differents immunosuppressive drugs.
Objective To determine the response time and immunosuppressive drugs used in a series of patients with LN.
Methods Retrospective analysis of Lupus patients in a single center with renal disease. The variables recorded were: the number of immunosuppressive drugs used from the diagnosis of LN until remission and the response evaluated regarding 24 hour proteinuria (achieve remission, improvement greater than or equal to 50% respect to baseline and/or no improvement).
Results In a series of 80 patients with SLE, 17 were diagnosed with NL, and of these, 14 proliferative diffuse glomerulonephritis (GN lV). The sample consists of 2 men and 12 women between 30 and 65 years of age, with a follow-up time of 6 to 55 months and 9 Caucasian and 5 Latin Americans. All patients were treated with hydroxychloroquine (HCQ), antihypertensive and corticosteroids. The immunosuppressant treatment used was: mycophenolate mofetil, azatioprine, cyclophosphamide, tacrolimus and rituximab. Considering that the time of follow-up of patients varies, each temporary space was analyzed according to the number of patients. Figure 1 shows that at 6 months, 38% of patients had an improvement >50% and 7.7% of patients achieved remission. After one year of treatment, 42% of patients presented improvement >50% and 17% achieved remission but in 23% of patients two changes of immunosuppressive treatment was needed. At 24 months, 50% of patients improved >50% and 25% achieved remission; in 13% of patients it was necessary to make another treatment change. Finally, after 24 months, it was observed that 50% of patients achieved remission, 33% of patients presented an improvement >50% and only 17% presented renal failure, and it was necessary to make another treatment change. Globally, in 36% of patients 1 or more changes of immunosuppressive treatment were necessary to achieve improvement >50% or remission.
Response time of the LN with immunosuppressive treatment regarding to 24h proteinuria. Blue: normal value of proteinuria 24 h, Red: improvement 50% compared to baseline, Green: no improvement or remission
Conclusions Patients who do not experience an improvement >50% in a period of 6 months are more likely to improve if a change in immunosuppressive treatment is made. It is necessary to extend the series to reach conclusions with statistical value.
Funding Source(s): No funding