Long-Term Clinical effects of intermittent intravenous cyclophosphamide on severe lupus nephritis

This long-term follow-up study evaluates the clinical efficacy, toxicity, and effects on renal histopathology of intravenous high dose cyclophosphamide (IVCY) therapy for severe active lupus nephritis patients. The clinical course and final outcome for each patient was evaluted by determining daily oral prednisolone dose. C3, C4, anti-dsDNA, Ccr, daily urine protein, serum albumin, hemoglobulin, blood urea nitrogen, creatinine and renal histopathology. This regimen resulted in significant improvement of daily prednisolone dosage, serum C3, C4, albumin, hemoglobulin and Ccr as early as the third month, and became further improved or stable through 24 months. The mean anti-dsDNA level, twenty-four-hour urine protein excretion, and serum urea nitrogen level showed statistical decrease at variable time course and there were no statistical changes in the serum creatinine level throughout this study. Renal biopsies were obtained in 10 out-of 11 patients at the beginning of treatment, and follow-up renal biopsies were performed in 7 out of 10 patients, and five patients showed improvement in histologic features and had predominent Class II. Even this was an retrospective and uncontrolled study, intermittent IVCY therapy seemed to be an effective regimen for severe lupus nephritis. However, further investigation and regular follow-up are necessary to elucidate the long-term effects and complications of IVCY therapy.