[Intermittent intravenous administration of cyclophosphamide in patients with lupus nephritis]

Patients with systemic lupus erythematosus (SLE) and lupus nephritis submitted to renal biopsy were retrospectively analyzed. All patients were admitted to Dubrava University Hospital, Department of Clinical Immunology and Rheumatology and Department of Nephrology. The diagnosis of SLE based on the criteria proposed by the American Rheumatology Association was made in 46 patients treated during the last 4 years. There were 39 female and seven male patients, mean age 39.5 years. Renal biopsy was performed in 16 patients (three male and 13 female, mean age 34 years).

Diffuse proliferative glomerulonephritis (type IV) was diagnosed in ten, focal segmental glomerulonephritis (type III) in three, and mesangioproliferative glomerulonephritis (type II) in two patients. The type of lupus nephritis was classified according to the World Health Organisation (WHO) criteria. In one patient, the tissue obtained proved inadequate for histologic analysis. Pulsed cyclophosphamide therapy was indicated in patients with lupus nephritis type III and IV (WHO). Cyclophosphamide was administered at a dose of 500-1000 mg i.v.. All patients received corticosteroids. One patient was administered intravenous immunoglobulin 400 mg/kg body weight. In ten out 13 patients with lupus nephritis types III and IV, the therapeutic protocol was completed, while the treatment is still under way in the remaining three patients. In nine and four of 13 patients, complete and incomplete remission was achieved after 6-month treatment, respectively. Two of 15 patients with type II mesangioproliferative glomerulonephritis were treated only with corticosteroids alone.

We believe that intermittent pulsed cyclophosphamide therapy produces favorable effects in the management of lupus nephritis type III and IV.