Treatment of Lupus Nephritis with Prednisone and Combined Prednisone and Azathioprine

Abstract

The relative effectiveness of high-dose prednisone (group A) was compared with the same regimen plus azathioprine (group B) for the treatment of lupus nephritis of mild or moderate severity over 6 months. Nephritis activity was graded by renal biopsy specimens; biopsies were repeated and rescored at 6 months. There was significant improvement in all patients of both groups. Creatinine clearance, urinary sediment abnormalities, proteinuria, hypocomplementemia, and high titers of antinuclear antibodies showed improvement in most patients, but none correlated completely with the improvement in renal biopsy scores. High doses of corticosteroids are effective in the short-term treatment of mild or moderately severe lupus nephritis; the addition of azathioprine over the short term does not improve the results. Two patients with severe lupus nephritis who were treated with steroids alone died within 2 months, so that a possible beneficial effect of added azathioprine in severe, advanced disease cannot be excluded.