Short-Term Outcome of Sub-Saharian Africans with Proliferative Lupus Nephritis Treated with Cyclophosphamide Versus Mycophenolate Mofetil
Published on: 2019-02-07
Introduction: The proliferative classes are the most frequent in the literature, varying between 40 and 80% of cases. They are indisputably those with the poorest prognosis in the medium term. We conducted this study to evaluate the progression aspects of proliferative lupus nephritis after induction therapy of sub-saharian Africans patients. Patients and Method: We performed a retrospective and descriptive study, over a period of 10 years in the nephrology department of Aristide Le Dantec hospital in Dakar. Patients with proliferative lupus nephritis were included. Results: In a total of 64 black patients with lupus nephritis, there were 44 cases of proliferative glomerulonephritis, a prevalence of 68.7%. The mean age of the patients was 31.8 ± 11.2 years. There were 33 women and 11 men, a sex ratio of 0.3. Hypertension was found in 22 patients. Mean serum creatinine was 24.2 mg / l ± 23.2. Renal failure was present in 45.5% of patients. Mean proteinuria was 3.9 g / 24 ± 2.7. Nephrotic syndrome was found in 72.7% patients. Class III was found in 11.3% of cases, class IV in 27.3%, the association of classes III and V in 43.2% and the association of classes IV and V in 18.2% of cases. Cyclophosphamide was used in 22 patients and mycophenolate mofetil in 10 patients. The rate of remission was higher in patients who were on mycophenolate mofetil than those who were on cyclophosphamide (66.6% versus 36.8%). Death was observed in 5 patients and the causes were pulmonary embolism, bacterial meningitis, pulmonary tuberculosis and indeterminate in 2 patients. Chronic renal failure was found in 8 patients. Infectious complications occurred in 38.6% of patients and cutaneous (32%), uro-genital (24%) and pulmonary (16%) localizations were the most frequent. Conclusion: The risk of progression to chronic renal failure was relatively high. The remission rate was higher in patients who were on mycophenolate mofetil. The hypothesis of an ethnic participation in the therapeutic response is debatable.