Lupus nephritis in Mexican patients: Response to intensive therapy

lupus nephritis represents a challenge in treatment. In spite of intensive therapy, is common a sustained renal incomplete response.

To describe different responses to adequate/intensive treatment to lupus nephritis.

Observational retrospective study, including Mexican>18 years old patients with lupus nephritis who visited tertiary rheumatology centers in several urban cities in Mexico. SLE was diagnosed according to 1997 ACR. The exclusion criteria were follow-up<6 months and reduced GFR due to other comorbidities such as diabetes or other primary renal disease.

We included 193 patients with a mean age of 34 years, 80% were women. Biopsy was available in 166 patients (86%): class IV in 42%, class III in 23%, the mean of activity and chronicity index were 6.4 and 2.6 respectively; class V represented 10.2%. The least frequent class was Class II (9%), and mixed classes (III or IV+V) accounted for 11%. Cyclophosphamide (CYC) was used in 146 patients (76.6%), mycophenolate (MMF) in 144 and tacrolimus (TCR) in 28. In most cases, were used combination therapy. Only 38 patients had a follow-up of less than 1 year; 16 (42%) had CR, 13 (34%) had NR, and 9 (23%) PR. 55% of patients with PR received a multitarget protocol, 75% of CR received the NIH protocol, and 61.5% of NR the NIH protocol. Of patients followed up for more than a year (155), 35% had persistently inactive response, 24.5% were relapsing-remitting, 20% were chronically active, and 20% showed a mixed pattern.

Prevalence of persistent or intermittent activity patterns was high (64.5%). Most Mexican rheumatologists switched to more intensive treatment, adding a second or third drug.