Abstract
Recent studies have shown that the course of lupus glomerulonephritis is usually one of inexorable progression to renal failure despite intensive treatment with glucosteroids. Seventeen patients were treated with low doses of prednisone (<20 mg/day) and azathioprine (2–3 mg/kg/day) for 6 to 36 months. Diagnosis of the renal lesion, by biopsy, included lupus glomerulitis (1), moderately severe glomerulonephritis (4) and severe glomerulonephritis (12). Seven cases with severe nephritis had the nephrotic syndrome and 9/17 were less than age 16 at onset. In one patient proteinuria increased after 24 months of therapy and another with severe renal failure at onset failed to respond. In the remaining 15 cases GFR either returned to normal (3) or remained normal (12). There was a significant reduction in proteinuria in every case, including a remission in 6 patients with the nephrotic syndrome. There was no evidence of progression of the renal lesion, by biopsy, in 9 patients reexamined, including the patient with uremia at onset. In 8 a striking decrease in severity was found, characterized by a relative absence of proliferation and reduction in deposition of electron-dense material. After 24 to 36 months of treatment in 5 patients with severe glomerulonephritis initially there were prominent membranous changes, by electronmicroscopy, which were indistinguishable from membranous nephropathy. This study demonstrates improvement in clinical and histological features of lupus glomerulonephritis with azathioprine-prednisone therapy. In addition, following suppression of the active proliferative lesion a new finding of membranous transformation was found.
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Hayslett, J., Cook, C., Kashgarian, M. et al. Effect of azathioprine in patients with lupus glomerulonephritis. Pediatr Res 5, 384–385 (1971). https://doi.org/10.1203/00006450-197108000-00058
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DOI: https://doi.org/10.1203/00006450-197108000-00058