Efficacy and toxicity of treatments for nephritis in a series of consecutive lupus patients

Objective: To study efficacy and toxicity of treatments for nephritis in a series of consecutive lupus patients. Methods: The case records of 40 patients with lupus nephritis followed up in a single center between 1992 and 2011 (median duration = 8.37 years) were retrieved to determine efficacy and toxicity of the treatments. Patients with class III/IV/V lupus nephritis were included. Results: Sustained responses were 21/40 (52.5%) at six months, 33/40 (82.5%) at 18 months and 30/40 (75.0%) at 36 months. Three deaths were observed after 18, 104 and 164 months of follow-up respectively, with one possibly associated with immunosuppression. Kidney survival was 100% at 18 months and 97.7% at 36 months. Kaplan-Meier's survival algorithm estimated a mean overall survival of 236.05 +/- 11.56 months and a kidney survival of 240.77 +/- 11.07 months. Kidney and overall survival were not significantly different among patients with different nephritis classes. Complications occurred in 12/40 (30.0%). Amenorrhea occurred in 20.7% of patients and was associated with higher cumulative doses of cyclophosphamide. Patients who achieved remission at 36 months or later had lower levels of proteinuria at 6 months (mean +/- SD = 0.93 +/- 0.97 g/24 h versus 2.60 +/- 2.11 g/24 h, p = 0.002) than non-responder patients. Conclusions: The data demonstrate that in the overall Caucasian population with lupus nephritis the combination of available therapeutic tools is effective and relatively well tolerated.