Hazards of pulse steroid use in a cohort of Egyptian lupus nephritis patients

Abstract

BackgroundPulse methylprednisolone is a tool for rapid immunosuppression in systemic lupus erythematosus (SLE) patients with life-threatening manifestations. Aim of the workTo assess the effect of the frequent use of high-dose pulse steroids on renal response and to detect any associated hazards in lupus nephritis (LN) patients with a disease duration >3 years. Patients and methodsMedical records of 90 Egyptian LN patients were revised every 6 months for the preceding 3 years. Patients’ examination was followed-up every 6 months for another year. Disease damage and activity (SLEDAI) indices were assessed; criteria for renal response evaluated, relevant laboratory investigations performed, and history of steroid therapy reported. ResultsThe patients mean age was 30.1 ± 8.3 years, 75 were females (83.3%) and 15 males (16.7%), mean SLEDAI was 7.6 ± 6.9 and damage index was 0.38 ± 0.95. All were on treatment with steroids and immunosuppressives. Those receiving frequent pulse-steroids (n = 71) had a significantly higher proteinuria and both significantly correlated throughout the study course (p < 0.001). A higher pulse-steroid dose was associated with poor renal response (p < 0.001). There was a significantly higher damage index in those receiving pulse compared to those not (p < 0.001). The cumulative steroid dose was significantly higher in patients with renal damage (n = 18), with cerebrovascular accident (n = 5) and with avascular necrosis of the hip (n = 8) than those without (p = 0.001, p = 0.047 and p = 0.001). ConclusionRepeated “pulse” steroid was associated with higher renal damage and deleterious effect on central nervous system and bone. The abuse of “pulse” steroid therapy should be avoided.