Treatment outcomes of Lupus Nephritis following the Induction Phase at Chris Hani Baragwanath Academic Hospital from 2010-2019

Abstract

Background. There is paucity of data from Africa on the treatment outcomes of Lupus Nephritis (LN). Objective. The primary objective of the study was to determine the LN treatment outcomes following the induction phase. Methods. This was a retrospective review of records of 61 patients with proliferative LN at a tertiary institution in Johannesburg, spanning a 10-year period. Results. The mean age at presentation was 30 years (IQR 22-36). The female to male ratio was 5:1. The majority of patients (90%) were black Africans. The commonest comorbidity was hypertension, which was present in 45.9% of the patients. Oedema was the most prevalent symptom at presentation, which was present in 82% of patients. The commonest class was LN class V, occurring in 60.7% of the patients. Most patients (68%) were diagnosed with LN at initial presentation with systemic lupus nephritis . A total number of 32 (52.5%) of the patients received cyclophosphamide (CYC) while 29 (47.5%) received mycophenolate mofetil (MMF). The proportion of patients who achieved complete remission was 44.3%, while 39.3% had partial remission and 16.4% did not respond to treatment. The side-effect profile between the two regimens was similar, with 18% of patients on CYC and 17,2% of patients on MMF reporting side effects. A chronicity score of 4 and above on histology was associated with poor clinical outcomes (p=0.03). Conclusion. The study showed that both mycophenolate mofetil and cyclophosphamide regimens have similar efficacy and side effect profile, which is comparable to the findings of other studies conducted elsewhere.