Original investigation: pathogenesis and treatment of kidney disease and hypertensionTreatment of pure membranous lupus nephropathy with prednisone and azathioprine: an open-label trial
Section snippets
Patients and methods
The Queen Mary, Tuen Mun, United Christian, and Prince Margaret Hospitals are 4 large regional hospitals in Hong Kong that serve a total population of at least 2 million. Between 1986 and 2001, consecutive patients with renal biopsy—proven pure membranous lupus glomerulonephritis (WHO Va and Vb) were recruited into an open-label treatment study consisting of prednisone and AZA. Renal biopsy samples were examined routinely by light microscopic, immunofluorescence, and electron microscopic
Results
Thirty-eight patients were studied. All were ethnic Chinese and fulfilled at least 4 of the American College of Rheumatology criteria for the classification of SLE.19 Table 1 shows their demographic and clinical manifestations at the time of renal biopsy. There were 31 women and 7 men, and the mean age was 35.0 ± 9.2 years. The mean duration of SLE was 48.5 ± 59 months. Twenty-two (58%) patients were nephrotic. Seven (18%) patients had received AZA previously because of extrarenal
Discussion
This is an open-label study of the therapeutic efficacy of prednisone and AZA in pure or minimally proliferative membranous lupus nephropathy. Our results show that a combination of prednisone and AZA is reasonably effective for the initial treatment and maintenance of pure membranous lupus nephritis. Renal remission occurred in 90% of patients in the first year of treatment. Extrarenal disease activity also improved significantly after treatment. With a mean follow-up of almost 8 years, only a
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2016, American Journal of Kidney DiseasesCitation Excerpt :Rathi et al59 also reported similar treatment response rates in a subgroup of patients with pure MLN in a randomized trial of induction with MMF or low-dose intravenous CYC (66.7% vs 71.4%) after 24 weeks. AZA combined with high-dose steroids has been reported as a successful and safe strategy for initial management for MLN, with 89% having complete or partial remission at 12 months.60 During the long-term follow-up, approximately one-third had a renal flare, which was most often nephrotic and responded to reinduction therapy with augmented steroid dose and another agent if required.22
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