Impact Of Methylprednisolone Treatment Of Type Iv Lupus Nephritis Efficacy And Safety Of Clinical Research

Background: Renal disease is one of the common complications of Systemic lupus erythematosus (SLE). Renal failure is a major cause of mortality in SLE. ClassⅣLupus nephritis (LN) carries the worst prognosis. Pulse Methylprednisolone (MP) at a dose of 1 g per day for 3 to 5 days has been used in the ClassⅣLN therapy for a long time. Although the effects of this therapy have been confirmed in the last studies, it is not neglectable that the serious side effects of pulse MP therapy are the independent factor for morbidity and mortality of lupus nephritis.Objectives: The purpose of this study is to investigate the efficiency and side effects in MP pulse therapy, and to clarify the prognosis factors of typeⅣlupus nephritis.Methods: Retrospective analyses were carried out on 82ⅣLN patients regularly followed-up in Peking Union Medical College Hospital since 2002 to 2006. Two groups, one with the MP pulse therapy (with MP pulse) and another without the MP pulse therapy (non-MP pulse) were included in this study. Serum creatinine (Scr), eGFR (estimated Glomerular filtration rate), blood urea nitrogen (BUN) , albumin (ALB) , self antibodies, 24-hour urine protein excretion were tested regularly and the side effects were observed in this study.Results:1. It was more serious in the patients with MP pulse group than the non-MP pulse group evaluated with the parameter of 24-hour urine protein excretion, ALB, serum Scr, BUN and HGB before treatment. There is no significant difference for those parameters between the two groups 2 months later (P>0.05). No significant difference among the different eGFR subgroups were observed both before and after treatment (P>0.05) in the two groups. Serum compliment C₃ and C₄ were observed below the normal values before treatment and comparable for the two groups (P>0.05). The compliment rose to the normal range after 3 weeks and recovered faster in the MP pulse group.2. Scr increased gradually after MP pulse. The first peak value was observed within the first week and a second peak value after 2 weeks. The significant renal function recovery was detected after 2 months.3.There were no significant differences of the remission rate and the Scr , serum ALB and 24-hour urine protein excretion between the two groups both in short-term and long-term observation(P>0.05).4. In the present study of total 82 cases, it was observed that the age(>25y), increasing of pretreatment period, BUN, C₄, negative anti-dsDNA antibody, hypertension, infection and anemia lasted over 1 month, hypoalbuminemia lasted for 3 months predicted bad prognosis.5. In the MP pulse group, larger amount of urine protein excretion was observed in theⅣ+Ⅴsubgroup than in theⅣsubgroup; and it was also observed that it relieved faster in theⅣ+Ⅴsubgroup. There was higher Scr in the subgroup (A/C) than subgroup (A) and maintained longer, even last 2 months later. In Subgroup (G) there were serious indices in Scr, loss of urine protein and initial ALB than in Subgroup(S).6. Infection was the most common side effects in MP pulse therapy. Infected patients had worse prognosis than those noninfected ones (P<0.05). Blood dissemination and multiple parts infection were easily caused by MP treatment. And the lower respiratory tract was the most susceptible. Gram-negative bacteria were the primary pathogenic bacteria, and some special infections like Pneumocystis carinii pneumonia (PCP), Cytomegalovirus (CMV) and TB etc were also observed. The susceptible factors of infection included MP pulse treatment,Ⅲ-Ⅳgrading bone marrow depressed, and serious anemia. The number of times of pulse treatment and hypoalbuminemia were not correlated with the susceptible factors.Conclusions: 1. The short-term and long-term effects of MP pulse therapy with ClassⅣLN patients were significant.2. Scr had acute reversible raise after pulse MP therapy, and reached a maximum within 1 -2 weeks. (A/C) subgroup has higher initial Scr. And the Scr decreased more slowly in this subgroup; inⅣ+Ⅴsubgroup, larger amount of urine protein excretion and relieving more slowly was observed than in ClassⅣsubgroup.3. The age(>25y), increasing of pretreatment period, BUN, C₄, negative of anti ds-DNA antibody, hypertension, infection and anemia lasted over 1 month, hypoalbuminemia lasted for 3 months predicted bad prognosis. Infection was the most common side effect in MP pulse therapy. Blood dissemination and multiple parts infection were easily caused by MP treatment. And some special infections like PC, CMV and TB etc were also observed. The susceptible factors of infection included MP pulse treatment,Ⅲ-Ⅳgrading bone marrow depressed, serious anemia.