Systemic lupus erythematosus and renal involvement. A South African experience

Renal involvement in systemic lupus erythematosus (SLE) often signifies a poor prognosis. Whilst SLE appears to be not uncommon in the racial groups of South Africa, there are few reports in the literature. Between 1984 and 1987, 43 patients with SLE and nephritis were analyzed. Clinical and biochemical manifestations are described. The histological types (WHO classification) were mainly class II (15 cases) and class IV (17 cases). The ratio of black to Indian patients was 26.4% in class II and 43.4% in class IV to 42% each in class II and class IV respectively. Immunofluorescence showed a predominantly granular pattern of IgG, C1 and C3. Treatment was with combinations of prednisone and cyclophosphamide (14 cases), prednisone and azathioprine (21 cases) or pulse methylprednisolone (6 cases; total 41 cases). Two patients were not treated. There was no difference between cyclophosphamide and prednisone (14 cases) and prednisone with azathioprine (21 cases) treatment groups. The follow-up period was for 4 years. Mortality occurred in 15 patients (35%). The main cause of death was renal failure in 10 patients, infection in 1 patient and central nervous system involvement in 1 patient. The prognosis was worse in the Indian compared with the black patients. The WHO classification did not give an accurate prognosis regarding mortality in our study. Because of limited resources for the treatment of chronic renal failure in developing countries, we feel that patients with lupus nephritis should be treated with improved ancillary medical therapies and more effective immunosuppressive regimens.