Treatment of Diffuse Proliferative Lupus Nephritis by Intravenous High-dose Methylprednisolone

Abstract

SUMMARY Twenty-five patients with diffuse proliferative lupus nephritis were treated with three consecutive Intravenous injections of 1 g methylprednisolone pulses followed by small doses of prednisone. These patients were followed for at least three months. Major side-effects were observed only in one patient. After steroid administration, extrarenal symptoms rapidly disappeared in all patients. Except for four patients with diffuse glomerular sclerosis a significant improvement of serum creatinine was observed after one month and the improvement was more sustained after three months. No deterioration was observed in patients with normal functioning kidneys. Proteinuria decreased significantly over three months. When tested, anti-dsDNA binding capacity and serum complement components became normal within four weeks. Seventeen patients were then followed for 12–93 months. Ten patients received only small doses of oral prednisone and seven were also treated with cytotoxic agents. Eight ‘flare-ups’ of disease occurred in these patients over a cumulative period of 688 months. Additional steroid pulses were administered during the ‘flare-ups’, with subsequent improvement of symptoms and renal function in all but one patient, who had diffuse glomerular sclerosis at biopsy. At present the mean values of serum creatinine are lower than baseline values. One patient has renal failure and another one has moderate renal insufficiency. No patient has the nephrotic syndrome and six patients are free from proteinuria. We suggest that aggressive treatment based on short-term intravenous methylprednisolone during relapse followed by a low-dose maintenance regimen may be a safe and effective way to manage most patients with diffuse lupus nephris.