Effect of Azathioprine on Renal Histology and Function in Lupus Nephritis

The effectiveness of azathioprine was assessed in a longitudinal study of 12 selected patients with varying degrees of lupus nephritis. All had substantial histological evidence of disease (five with lupus glomerulitis and seven with lupus glomerulonephritis), and eight had an initial glomerular filtration rate of less than 80 ml/min 1.73 sq m. Clinical improvement or stability was observed in all patients and confirmed by serial renal clearance studies and protein excretion rates. Histologic evidence of acute glomerular involvement diminished in all patients, in association with the evolution of glomerulosclerosis. Seven patients were able to discontinue corticosteroids without clinical deterioration. Eight patients with initial renal insufficiency remained clinically stable with a mean survival of 32.5 months. Thus, azathioprine appears to offer considerable therapeutic benefit to selected patients with lupus nephritis.

Approximately 50% of patients with systemic lupus erythematosus (SLE) develop clinical evidence of renal disease, and about half of these succumb