Balow JE, Boumpas DT, Fessler BJ, Austin HA III
Management of lupus nephritis
Kidney Int (Suppl 53)
(Jan) 49:S88-92 1996

Balow and his colleagues from the NIH review treatment of lupus nephritis
focusing primarily on their clinical trials comparing effects of
corticosteroids and cytotoxic drugs. The authors point out that the rate
of renal failure may not be altered initially in patients treated with both
corticosteroids and cyclophosphamide. However, with follow-up for a
median duration of seven years, their studies have demonstrated the
probability of developing end stage renal failure to be lower with
intermittent pulse cyclophosphamide than with prednisone alone. Studies by
this same group comparing only intermittent pulse-methylprednisolone with
cyclophosphamide have shown that patients treated with pulse
methylprednisolone only
have a higher probability of doubling of their serum creatinine levels.
The authors specify their preference for monthly pulses for six months
followed by quarterly pulses
of cyclophosphamide with maintenance treatment continued one year beyond
remission.
Herpes zoster is the only major infection more likely to occur in
cyclophosphamide treated patients. While ovarian failure can occur,
hemorrhagic cystitis and disseminated malignancy have not been seen in
patients treated with pulse cyclophosphamide at the NIH. Though the
discussion of other therapeutic options is superficial, it references many
recent studies. While this manuscript lacks depth, it is useful in its
distillation of data from many trials and a cyclophosphamide treatment
protocol that is so concise it will likely become a part of many handbooks.
N. Kevin Krane, M.D.