Efficacy of standard treatment protocol in recently diagnosed Lupus Nephritis at our tertiary care teaching hospital

Abstract

Introduction: Lupus Nephritis occurred in approximately 50% of Systemic Lupus Erythematosus patients at some point during their illness and is associated with a poor prognosis.

Material and Method: A prospective observational study of 50 newly diagnosed LN cases was conducted to investigate the response of standard treatment protocol (Cyclophosphamide -NIH protocol and Mycophenolate Mofetil-MMF).

Results: Of the 50 newly diagnosed cases of LN, 94 % (n=47) were females, and 6 % (n=3) were males, with class IV LN accounting for the majority of patients 69.39 % (n=34). At six months, 36.7 % (n=11) of patients in the cyclophosphamide (CYP) group had a complete response. Only 27.3 % of patients in the MMF group had a complete response; however, this difference was not statistically significant. At the end of one year, only 56.7 % of the CYP group and 81.8 % of the MMF group had a complete response; however, this difference was not statistically significant (p=0.282). Although the initial response with CYP was better and later in the MMF group, these differences were not significant statistically. Tuberculosis or its reactivation was the most common complication during treatment, either with MMF or CYP. One patient died due to latent tuberculosis reactivation, another as a result of severe disease activity at presentation (proteinuria was 20 gm/24 hours in that patient), and the third as a result of pneumonia with septicemia.

Conclusion: Treatment with either CYP or MMF is equally effective, but underlying infection, particularly tuberculosis, should be ruled out before initiating therapy.