Short-Term Outcomes of Lupus Nephritis: A Single-Center Experience From South India

Background Systemic lupus erythematosus is a multisystem chronic autoimmune disease that predominantly affects women of reproductive age. Patients with lupus nephritis (LN) are at an increased risk of mortality. Methodology In this study, we aimed to compare the efficacy of three different induction regimens, namely, the National Institutes of Health (NIH) regimen, the European Lupus Nephritis Trial (ELNT) regimen, and the mycophenolate mofetil (MMF) regimen, for the treatment of proliferative LN in our study population. Results Of the 50 patients, 49 (98%) were women. The mean age, urine protein-creatinine ratio, and serum creatinine of the study participants at the time of diagnosis were 31.96 ± 10.68 years, 2.52 (1.2-4.05) mg/mg, and 1.44 (0.8-1.72) mg/dL, respectively. On renal biopsy, 12 (24%) had class III, 8 (16%) had class III + V, 23 (46%) had class IV, and 7 (14%) had class IV + V LN. Based on factors such as disease activity, patient's age, risk of infertility, treatment adherence, prior exposure to cyclophosphamide, and patient willingness, 12 (24%) were treated with the NIH regimen, 18 (36%) with the ELNT regimen, and 20 (40%) with oral MMF as induction regimen. At the end of six months, outcomes were assessed. In the NIH group, 83.34% achieved complete remission and 16.67% achieved partial remission. In the ELNT group, 61.1% achieved complete remission, while 38.89% achieved partial remission. In the MMF group, 80% achieved complete remission, 10% achieved partial remission, and 10% did not achieve any remission after six months. No statistically significant difference in response was found between the three induction treatment groups (p = 0.114). The occurrence of intercurrent infections during treatment was 16.67% in the NIH group, 22.2% in the ELNT group, and 20% in the MMF group, without any statistically significant difference in the infection rate between the groups (p = 0.697). Conclusions This study demonstrates that the NIH, ELNT, and MMF regimens are equally effective and safe in inducing remission in patients with proliferative LN in our study population.