The optimal treatment of the proliferative forms of kidney disease associated with systemic lupus erythematosus is controversial. The efficacy of intensive, intermittent immunosuppressive drug therapy is being evaluated in patients with active lupus glomerulonephritis. A comparison is being made between intermittent pulse doses of corticosteroid and cyclophosphamide, as well as between a short and long course of pulse cyclophosphamide. Patients with renal biopsy documented active glomerulonephritis are treated with prednisone and randomized to receive concomitantly (a) intravenous pulse methylprednisolone monthly for 6 months, or (b) intravenous pulse cyclophosphamide monthly for 6 months, or (c) pulse cyclophosphamide monthly for 6 months followed by a maintenance regimen of pulse cyclophosphamide every 3 months for an additional two years. During the final 24 months of the study, all patients continue to receive low dose, alternate day prednisone. Active disease, as manifested by renal functional deterioration, increased proteinuria or worsened urinary sediment, is treated by increased prednisone. Comparison will be made of the number of favorable outcomes of renal function, glomerular pathology and drug related toxicities occurring in each treatment.
