Lupus nephritis: low-dose glucocorticoids in a systemic autoimmune diseases unit

Introduction: current recommendations to treat lupus nephritis (LN) point to low-dose glucocorticoids to control the disease and avoid cumulativedamage. Objective: to learn about and compare the response of patients with proliferative LN who are treated following two prednisone therapy guidelines: reduced initial doses <= 30 mg/d and standard initial doses >30 mg/d during the induction stage. Method: clinical, analytical and therapeutic guidelines of patients with proliferativeLNwere compared and classified into two groups according to the standard or low-dose initial prednisone dose. Results: 21 patients with proliferative LN were studied (n=12 low-dose initial prednisonevs. n=9 standard initial prednisone). No significant differences were found between clinical and analytical variables, although a significantly different statistic difference was observed in the number of methylprednisone pulses (5 +/- 2.95 initial prednisone <= 30 mg/d vs 2.33 +/- 2.91 initial prednisone >30 mg/d, p = 0.041) and in the prednisone dose accumulated in 6 months (12.8 mg +/- 4.9 initial prednisone <= 30 mg/d vs 30.0 +/- 13.1 mg initial prednisone >30 mg/d, p =0.008). No significant differences were seen between both groups in the proportion of patients who achieved complete response, neither in terms of the time it took to achieve it or in the side effects. Conclusions: the treatment plan for the initial prednisone <30 mg/d was associated to a lower cumulative dose of response prednisone considering the comparable treatment, what suggests there being smaller cumulative harm as a consequence of the use of glucocorticoids.