The Treatment of Lupus Nephritis: Revisiting Galen
Authors: Edmund J. Lewis
Journal: Annals of Internal Medicine (2001)

Editorials21 August 2001The Treatment of Lupus Nephritis: Revisiting GalenEdmund J. Lewis, MDEdmund J. Lewis, MDRush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-135-4-200108210-00014 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The therapeutic approach to the patient with lupus nephritis is controversial. The medical literature contains a surfeit of expert opinion and scant scientific evidence. Many opinions about the treatment of lupus nephritis are based on faith rather than valid observation. When faith rather than evidence is used to support clinical decisions, the treatment chosen becomes, like religion, a matter of personal preference.Despite continuing improvement in outcomes, renal failure and death remain common among patients with lupus nephritis (1). The literature is burdened with clinical anecdotes and suboptimally designed clinical studies. Few controlled clinical trials have been reported, and meta-analyses ...References1. Cameron JS. Lupus nephritis. J Am Soc Nephrol. 1999;10:413-24. [PMID: 10215343] CrossrefMedlineGoogle Scholar2. Illei GG, Austin HA, Crane M, Collins L, Gourley MF, Yarboro CH, et al . Combination therapy with pulse cyclophosphamide plus pulse methylprednisolone improves long-term renal outcome without adding toxicity in patients with lupus nephritis. Ann Intern Med. 2001;135:248-57. LinkGoogle Scholar3. Felson DT, Anderson J. Evidence for the superiority of immunosuppressive drugs and prednisone over prednisone alone in lupus nephritis. Results of a pooled analysis. N Engl J Med. 1984;311:1528-33. [PMID: 6390198] CrossrefMedlineGoogle Scholar4. Bansal VK, Beto JA. Treatment of lupus nephritis: a meta-analysis of clinical trials. Am J Kidney Dis. 1997;29:193-9. [PMID: 9016889] CrossrefMedlineGoogle Scholar5. Korbet SM, Lewis EJ, Schwartz MM, Reichlin M, Evans J, Rohde RD. Factors predictive of outcome in severe lupus nephritis. Lupus Nephritis Collaborative Study Group. Am J Kidney Dis. 2000;35:904-14. [PMID: 10793026] CrossrefMedlineGoogle Scholar6. Cupps TR. Cyclophosphamide: to pulse or not to pulse? [Editorial]. Am J Med. 1990;89:399-402. [PMID: 2220873] CrossrefMedlineGoogle Scholar7. Strauss MB. Commentary. Milbank Memorial Fund Quarterly. 1969; 67(Part 2):80. Google Scholar8. Gourley MF, Austin HA, Scott D, Yarboro CH, Vaughan EM, Muir J, et al . Methylprednisolone and cyclophosphamide, alone or in combination, in patients with lupus nephritis. A randomized, controlled trial. Ann Intern Med. 1996;125:549-57. [PMID: 8815753] LinkGoogle Scholar9. Levey AS, Lan SP, Corwin HL, Kasinath BS, Lachin J, Neilson EG, et al . Progression and remission of renal disease in the Lupus Nephritis Collaborative Study. Results of treatment with prednisone and short-term oral cyclophosphamide. Ann Intern Med. 1992;116:114-23. [PMID: 1727614] LinkGoogle Scholar10. Steinberg AD, Steinberg SC. Long-term preservation of renal function in patients with lupus nephritis receiving treatment that includes cyclophosphamide versus those treated with prednisone only. Arthritis Rheum. 1991;34:945-50. [PMID: 1859488] CrossrefMedlineGoogle Scholar11. Castle WB. Lectures on the Anaemias and Vitamin Deficiencies. Melbourne: Melbourne Permanent Postgraduate Committee; 1939 Google Scholar Author, Article, and Disclosure InformationAuthors: Edmund J. Lewis, MDAffiliations: Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612Corresponding Author: Edmund J. Lewis, MD, Rush-Presbyterian-St. Luke's Medical Center, 1653 West Congress Parkway, Chicago, IL 60612. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCombination Therapy with Pulse Cyclophosphamide plus Pulse Methylprednisolone Improves Long-Term Renal Outcome without Adding Toxicity in Patients with Lupus Nephritis Gabor G. Illei , Howard A. Austin III , Marianna Crane , Lee Collins , Mark F. Gourley , Cheryl H. Yarboro , Ellen M. Vaughan , Takashi Kuroiwa , Carol L. Danning , Alfred D. Steinberg , John H. Klippel , James E. Balow , and Dimitrios T. Boumpas Metrics Cited by¿Cuál es el mejor tratamiento de mantenimiento de la nefritis lúpica tipo IV?How did cyclophosphamide become the drug of choice for lupus nephritis?Lupus NephritisTratamiento inmunosupresor en pacientes con glomerulonefritis lúpica. Revisión de eventos adversosThe American college of rheumatology response criteria for proliferative and membranous renal disease in systemic lupus erythematosus clinical trialsGlomérulonéphrite extra-membraneuse au cours d’un syndrome de Gougerot-Sjögren primitifOutcome of Chilean Patients with Lupus Nephritis and Response to Intravenous CyclophosphamideRein, lupus et grossessePulsed IV regimen beneficial in lupus nephritis? 21 August 2001Volume 135, Issue 4Page: 296-298KeywordsAttentionBiopsyClinical trial reportingCreatinineCyclophosphamideInflammationLupus nephritisPatientsSystemic diseasesToxicity ePublished: 21 August 2001 Issue Published: 21 August 2001 Copyright & PermissionsCopyright © 2001 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...