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Related Experiment Videos

Treatment for lupus nephritis.

R S Flanc1, M A Roberts, G F M Strippoli

  • 1Nephrology, Monash Medical Centre, Clayton Rd, Clayton, VIC, Australia.

The Cochrane Database of Systematic Reviews
|February 20, 2004
PubMed
Summary

Cyclophosphamide combined with steroids is the best treatment for lupus nephritis (LN) to preserve kidney function, despite risks like ovarian failure. Azathioprine also reduces mortality in LN patients.

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Area of Science:

  • Nephrology
  • Rheumatology
  • Immunology

Background:

  • Lupus nephritis (LN) is a severe kidney complication of systemic lupus erythematosus (SLE), primarily affecting young women.
  • WHO Class IV LN has a poor prognosis, but survival rates have improved with treatments like cyclophosphamide and steroids.
  • Understanding treatment benefits and harms is crucial for managing this debilitating condition.

Purpose of the Study:

  • To evaluate the efficacy and safety of various treatments for biopsy-proven proliferative lupus nephritis (PLN).
  • To compare outcomes such as renal function decline, mortality, and treatment-related harms.

Main Methods:

  • A systematic review of randomized controlled trials (RCTs) and quasi-RCTs was conducted.
  • Searches included major databases like Cochrane, MEDLINE, and EMBASE up to January 2003.

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  • Data extraction and quality assessment were performed independently by two reviewers.

    • Main Results:

    • Cyclophosphamide plus steroids reduced doubling of serum creatinine compared to steroids alone but did not impact mortality. Ovarian failure risk increased significantly.
    • Azathioprine plus steroids reduced all-cause mortality but did not improve renal outcomes.
    • Plasma exchange showed no significant benefit for mortality, renal function, or end-stage renal failure when added to standard therapies.

    Conclusions:

    • Cyclophosphamide with steroids remains the optimal choice for preserving renal function in proliferative LN pending further research on newer agents.
    • Minimizing drug dosage and treatment duration is recommended to reduce gonadal toxicity without compromising effectiveness.
    • Further RCTs are needed to explore novel therapeutic options for lupus nephritis.