Sequential Therapy for Diffuse Proliferative and Membranous Lupus Nephritis: Cyclophosphamide and Prednisolone Followed by Azathioprine and Prednisolone

A retrospective single-center cohort study on 35 patients with diffuse proliferative and/or membranous lupus nephritis evaluated a sequential treatment regimen of prednisolone and cyclophosphamide followed by low-dose prednisolone and azathioprine. Over a follow-up period of approximately 33 months, 94.3% of patients achieved complete or partial renal remissions, with significant differences in remission rates between the different types of lupus nephritis. Relapse occurred in a small number of patients, and no mortality or significant increase in serum creatinine levels was observed. Adverse effects included hair loss (42.9%), transient amenorrhea (53.6%), leukopenia (11.4%), febrile episodes (14.3%), and herpes zoster (28.6%). The study concluded that this sequential therapy was effective in achieving favorable outcomes with manageable toxicities.