Role of intravenous cyclophosphamide in lupus nephritis patients with renal impairment

Twenty-three patients with lupus nephritis (21 diffuse proliferative glomerulonephritis and two with focal proliferative glomerulonephritis) with impaired renal functions were evaluated for their response to pulse cyclophosphamide. Diagnosis of lupus nephritis was based on American rheumatism association criteria or on the basis of renal manifestations with high anti dsDNA antibody titres. Cyclophosphamide was given in dosage of 900 mg/m(2) as infusion in 500 mL of 5% dextrose (reduced by 25% if serum creatinine was more than 6 mg/dL) once every month for 6 months then 3 monthly for a minimum of 3 years. Response was defined by 24 h protein excretion less than 500 mg and serum creatinine less than 1.4 mg/dl. Nine patients (group I) had normal function (serum creatinine 1.16 +/- 0.21 mg/dL) and 14 patients (group II) had impaired renal function at presentation (serum creatinine 3.72 +/- 4.06 mg/dL). Both groups were compared for response to therapy. All patients in group I were in complete remission at last follow up of 44.6 +/- 8.3 months (serum creatinine 1.14 +/- 0.2 mg/dL, 24 h proteinuria 0.3 +/- 0.3 g). While in group 2, 13 patients showed improvement. Two patients were in complete remission, seven in partial remission, one patient died and four patients had mild renal failure at last follow up of 40.2 +/- 10.4 months (serum creatinine 1.81 +/- 0.74, 24 h proteinuria 2.19 +/- 2.54 g) The side effects of therapy included infection, transient leucopenia and vomiting. We conclude that intravenous (I.V) cyclophosphamide is an effective therapy in severe lupus nephritis with renal impairment.