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Rheumatology Advance Access originally published online on January 19, 2008
Rheumatology 2008 47(3):311-314; doi:10.1093/rheumatology/kem365
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

The difference between lupus nephritis class IV-G and IV-S in Koreans: focus on the response to cyclophosphamide induction treatment

Y. G. Kim1,*, H. W. Kim2,*, Y. M. Cho3, J. S. Oh1, S.-S. Nah1, C.-K. Lee1 and B. Yoo1

1Division of Rheumatology and 2Division of Nephrology, Department of Internal Medicine and 3Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

Correspondence to: B. Yoo, Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, Korea. E-mail: byoo{at}amc.seoul.kr


  Abstract

Objectives. To evaluate the response to induction therapy with intravenous (IV) cyclophosphamide (CYC) in Korean patients with class IV-G (diffuse global proliferative glomerulonephritis) and class IV-S (diffuse segmental proliferative glomerulonephritis) lupus nephritis (LN) according to the classification system of the International Society of Nephrology/Renal Pathology Society (ISN/RPS).

Methods. Of the 52 patients with biopsy-proven diffuse proliferative LN, who had been treated with IV CYC over a 10-yr period, 42 had been treated with IV CYC (equal to or more than 500 mg) for 6 consecutive months and had biopsy specimens containing more than nine glomeruli. The renal pathology of these 42 patients was reclassified according to the International Society of Nephrology and the Renal Pathology Society 2003 classification, and their renal response rates and laboratory indices after induction therapy were analysed.

Results. Of the 42 patients assessed, 30 (71%) had IV-G and 12 (29%) had IV-S. Pre-treatment 24 h urinary protein was significantly higher and pre-treatment concentration of anti-dsDNA antibody was significantly lower in IV-G than in IV-S patients. Following induction therapy, complete remission rates were significantly higher in patients with IV-S (67%, 8/12) than in patients with IV-G (33%, 10/30) LN.

Conclusions. Class IV-G LN responded more poorly to induction therapy with IV CYC pulse than class IV-S LN.

KEY WORDS: Lupus nephritis, Cyclophosphamide, Remission induction

*Y.G. Kim and H.W. Kim equally contributed to this work.

Submitted 21 June 2007; revised version accepted 7 December 2007.
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