[Appraisal of renal failure reversing therapies in lupus nephritis]

This study aimed to explore the therapies of reversing renal failure in lupus nephritis.

The research strategy was a retrospective cohort study. 173 patients were included in the study. All of them were consecutive in-patients of newly diagnosed renal failure (serum creatinine > 180 micromol/L) with lupus nephritis from 1991 to 1999 in the university hospital. The research factors included steroids, cyclophosphamide and cyclosporin. Steroids were divided to oral prednisone, intravenous dexamethasone and intravenous methylprednisolone pulse; cyclophosphamide dose intensity was divided into three grades: none, low dose (average dose 0.25 g/m(2) body surface area per week). 51 demographic, clinical and laboratory data were included in the study as possible confounding factors. The study end-point was recovery of renal function that was defined as a level of serum creatinine

The number of complete following up patients was 142 (82.1%). After over 6 months of following up, 93 cases (65.5%) recovered their renal function and 17 cases (12.0%) died. In COX proportional hazard regression model, cyclophosphamide therapy was significantly associated with the recovery of renal function. The adjusted hazard ratio (HR) to recovery of renal function was 4.41, 95% CI = 1.03 - 18.94 in low dose; and the HR was 13.29, 95% CI = 3.11 - 56.82 in high dose cyclophosphamide therapy. The gender, duration of renal dysfunction, small renal size, severe anemia and serum creatinine were also significantly associated with renal function recovery. Cyclophosphamide therapy was not significantly associated with death. The variables associated with death were low level of serum albumin and edema.

Cyclophosphamide pulse was an efficient therapy in reversing renal failure of lupus nephritis, especially in the patients with short duration of renal failure, non-small in renal size, and non-severe anemia.