<prompt> Indications for use of cyclophosphamide in SLE is: PGI Nov 2010ArthritisAnti D NA antibody ive patientsDiffuse proliferative glomerulonephritisOral ulcers  <response>: Ans: C Diffuse,. WHO Classification of Lupus Nephritis. Five Patterns Robbins 7th 231minimal or no detectable abnormalities class Imesangial lupus glomerulonephritis class IIfocal proliferative glomerulonephritis class IIIdiffuse proliferative glomerulonephritis class IVmembranous glomerulonephritis class VProliferative Lupus Nephritis CRDT2nd490Several important trials conducted at the National Institutes of Health provided the rationale behind the current therapeutic regimens used to treat proliferative lupus nephritis. Key findings from these trials are as follows: 1 treatment with intravenous pulse cyclophosphamide CYC is superior to high-dose oral prednisone alone in preventing progression to end-stage renal disease, and 2 an extended course of CYC six monthly pulses followed by quarterly pulses for 2 years is more effective than pulse methylprednisolone and shorter courses of CYC in preserving renal function and preventing renal relapse. Thus the use of monthly intravenous pulse CYC in conjunction with high-dose glucocorticoids followed by quarterly pulse CYC became the standard of care in the communityData suggest that cyclophosphamide is effective in most patients with severe lupus nephritis over both the short and the long term; many experts believe that it should be included in initial therapeutic regimens in most SLEpatients with severe nephritis or other life-threatening, rapidly progressive organ involvement. IV cyclophosphamide is effective in some patients with serious extra re nai manifestations ofSLE, including diffuse CSS disease, thrombocytopenia, and interstitial pulmonary inflam motion- Kelly Textbook of Rheumatology 7th548SLE Harrison 17th2080-82Cytotoxicimmunosiippressive agents added to glucocorticoids are recommended to treat serious SLE. Almost all prospective controlled trials in SLE involving cytotoxic agents have been conducted in patients with lupus nephritis, and always in combination with glucocorticoids.In patients whose renal biopsies show iSN grade HI or IV disease, early treatment with combinations of glucocorticoids and cyclophosphamide reduces progression to ESRD and improves survival. Prospective controlled trials in SLE but is nonetheless used by some clinicians.Since it has potential nephrotoxicity, but no hone marrow toxicity, the author uses it in doses of 3-5 mgkg per day PO in patients with steroid-resistant cytopenias of SLE or in steroid-resistant patients who have developed bone marrow suppression from standard cytotoxic agents.it is important to note that there are few if any randomized, controlled, prospective studies of any agents in life- threatening SLE that does not include nephritis. Therefore, use of glucocorticoids plus cyclophosphamide or mycophenolate in other life-threatening conditions is based on studies in nephritis. 