Introduction: Lupus membranous nephropathy (MN) is associated with a substantial risk of developing end-stage renal disease and may thus be fatal. There is currently no consensus about specific immunosuppressive treatment. We describe the presentation of lupus MN and its course according to type of immunosuppressive treatment.
Patients and methods: This retrospective study included all patients with lupus MN (only, not associated with any proliferative nephropathy) hospitalized in the nephrology unit of Ibn Sina University Hospital in Rabat from 1994 through 2005.
Results: MN was found in 18 patients, 16.7% of our patients with lupus. The average age at first admission of these 18 was 29+/-2.1 years (17-52), with a sex ratio of 0.12. The mean follow-up period was 54+/-31 months (3-130). The initial clinical presentation of MN was marked by the presence of proteinuria, nephrotic in 11 cases. Mean serum creatinine was 18.6+/-3.9 mg/L. Leukocyturia was noted in 12 cases (67%) and microscopic hematuria in 8 cases (44%). Extrarenal signs were cutaneous (14 cases), articular (14 cases), hematologic (8 cases), cardiac (6 cases) and neurological (4 cases). Patients were treated by corticosteroids only (group 1=7 cases) or by corticosteroids combined with cyclophosphamide in cases of renal insufficiency or neurological signs (group 2=11 cases). Complete remission occurred in 11 cases, and partial remission in the others. Four relapses were observed, including three in group 2. Mean serum creatinine blood levels were comparable in the 2 groups. Four patients died of extrarenal causes. Only one patient, in group 2, progressed to end-stage renal disease.
Conclusion: The initial presentation of lupus MN is variable. Cyclophosphamide has favorable renal effects, but does not prevent lethal complications, especially neurological complications.