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Very long-term outcome of pure lupus membranous nephropathy treated with glucocorticoid and azathioprine
Lupus, 09/21/09

Mok CC et al. – Treatment with high-dose prednisolone and AZA is effective, inexpensive and well-tolerated.

• A cohort of patients with SLE who had biopsy-confirmed pure MLN was treated initially with prednisone (0.8–1.0 mg/kg/day) and AZA (targeted to 2 mg/kg/day)
• 38 patients were studied (31 women; age 35.0 ± 9.2 years; mean SLE duration 48.5 ± 59 months; WHO Class Va 45%, Vb 55%)
• All patients were treated with prednisolone (0.85 ± 0.24 mg/kg/day) and AZA (1.72 ± 0.43 mg/kg/day)

• At 12 months, 24 (67%) patients achieved complete response (CR), 8 (22%) had partial response (PR) and 4 (11%) were treatment resistant
• After a follow-up of 12 ± 5.8 years, 19 episodes of renal flares (15 proteinuric and 4 nephritic) occurred in 13 (34%) patients
• The cumulative risks of renal flares at 5, 10 and 15 years were 19.4, 32.0 and 36.8%, respectively
• Retreatment with an augmented dosage of prednisolone, ± another immunosuppressive agent, resulted in CR and PR in 15 (79%) and 4 (21%) of these flare episodes, respectively.
• At last visit, three (8%) patients had doubling of serum creatinine, whereas six (16%) patients had decline of creatinine clearance by 30% (none developed end stage renal failure)
• Seven episodes of thromboembolic complications occurred in five (13%) patients and 11 episodes of infective complications (five major, six minor) were reported in seven (18%) patients
• In the absence of co-existing proliferative lesions, MLN runs a relatively benign course with low risk of renal function deterioration

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