الفهرس 
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Abstract
The present work aimed to identify the clinical, laboratory and
histopathological characteristic of severe proliferative lupus nephropathy,
which may also predict the indices for response and using
cyclophosphamide therapy in future patients with severe proliferative lupus
nephropathy. The subjects of this work comprised 75 eligible patients who
had severe proliferative nephropathy class III and class IV (WHO
classifications). All patients were subjected to thorough clinical, laboratory,
histopathological evaluation emphasizing the role of pathologic indices in
the managementand prediction of renal outcome in severe lupus nephritis.
The analysis of data showed that monthly intravenous pulse
cyclophosphamide with initial dosage 0.5-1.0 gm/m2 of BSA, does induce
rapid and sustained remission without relapse in the majority of patients, but
not all patients, up to 12 month follow up period and appears to have a
reasonable safety profile despite potential for major toxicity.
An interesting observation in our analysis is that despite the
significant associations shown in univariate analysis between several
studied potential predictor variables and outcome such as degree of
improvement of CNS manifestations, arthritis, oedema and hypertension,
serum creatinine, 24-hour urinary protein excretion rate, microscopic
haematuria, anaemia, C3 level, degree of mesangial proliferation, degree of
cellular crescent, interstitial fibrosis, degree of fibrous crescent and degree
glomerulosclerosis in initial renal biopsy, logistic regression analysis yielded
only 4 strong predictors, serum creatinir:9 at presentation, 24-hour urinary
protein excretion rate, namely degree of glomerulosclerosis and fibrous
crescent in initial renal biopsy. The identified 4 strong predictor variables
individually or in combination may be considered as strongest indices for
using IV.Cy, therapy and outcome predictions in future patients with severe
proliferative lupus nephritis, class III and class IV-WHOclassification.
The negative correlation between histological activity and chronicity
scores and outcome predictions, and also failure of either AI or CI to appear
in final logistic regression model as predictors were observed in our study.
However, despite that, the extreme variability and unpredictability of
severe lupus nephropathy and difficulty of therapeutic decision-making of
lupus nephritis, we believe that, all patients with class 11\ and class IV-WHO
classification must take the chance of therapy at least for 3 months hand in
hand with carefully respecting the strongest set of clinical, laboratory,
histopathology predictor variables to tailor proper therapy for each patient
with significant outcome predictions.
Thus, we have concluded that, excellent initial and sustained
remission without relapse was achieved in majority, but not all patients, with
severe lupus nephropathy treated with IV.Cy. therapy and appears to have
safety profile up to 12 month follow up period. The identified adverse
predictors of response with significant outcome predictions based on 2
strongest laboratory variables (serum creatinine and 24-hour urinary protein
excretion rate) were significantly enhanced by the addition 2 strongest initial
biopsy variables (degree of sclerosis and fibrosis). Consideration of these
strong prognostic predictors may contribute to decision-making regarding
the type, intensity and response of therapy with significant outcome
predictions in future patients with severe lupus nephropathy. And that, as
regard to the evidence about limitation of IV.Cy. therapy in some cases and
need for developing and evaluating alternative therapy is highly
recommended.