Safety and efficacy of low-dose glucocorticoid regimen in the induction phase treatment of class 4, 5 lupus nephritis

Abstract

Background Renal involvement in systemic lupus erythematosus is known as lupus nephritis (LN). LN presents with varied renal features. Class 4 and 5 LN are traditionally treated with prolonged standard high doses of prednisolone with various immunosuppressants such as cyclophosphamide and mycophenolate. These high doses of prednisolone are associated with numerous side effects. There is deficient data on the dose, duration of glucocorticoid therapy, and also paucity of data on comparison between the standard dose versus low-dose glucocorticoid therapy. Hence, this study can help in evaluating the use of low-dose glucocorticoids, its impact on renal outcome, and looking at side effects. Materials and methods It was a retrospective observational study conducted to look at the safety and efficacy of low-dose glucocorticoid regimen in induction phase treatment of class 4, 5 LN. Results On treatment, it was found that the resolution of microscopic hematuria, and improvement of low C4, and hypoalbuminemia were statistically significant in the low-dose steroid group. The resolution of proteinuria was seen in both groups and the resolution of renal failure was noted in both groups but was statistically significant in the standard dose group. Increased incidence of steroid-related complications was seen in the standard dose steroid group. Conclusions These findings possibly indicate that low-dose steroid therapy is good enough to treat LN with proteinuria, but a standard dose steroid is required in the presence of renal failure in LN, though increased incidence of steroid-related complications was seen in the standard dose steroid group.