Objective: To analyze the renal outcome in A-A patients with severs lupus nephritis that had renal biopsy and were treated with intravenous cyclophosphamide (IVCY) and steroids or steroids alone (STD). Methods: We reviewed our experience with 21 cases of biopsy prover lupus nephritis in A-A patients. All the patients fulfilled the ACR classification criteria for SLE. Mean age of onset was 29.9±9.6 years; mean follow-up after renal biopsy was 3 (range 11 to 60) months. Clinical and serological manifestations were obtained from our computerized database. Biopsy was performed in the first few weeks of the initiation of illness. All patients exhibited active urinary sediment with many RBC, WBC , and hyaline and RBC , casts, nephrotic syndrome was present in 12 (57.1%)patients, hypertension in 9 (42.8%).ANA seropositive in all patients, dsDNA in 11(52%), anti Sm in 5(23%),RNP 7(33%),SSA in 7(33%),SSB in 4(19%)patients. Results: Thirteen patients received a similar protocol of IVCY (500-1000 mg/m2) monthly for six doses, and then every third month (unless progressive renal impairment developed). Mean number of doses was 10.9±6.7. All patients received high doses of steroids. In the IVCY group 9(69%) patients showed significant clinical and laboratory improvement, in 4 (31%) patients renal function deteriorated despite therapy. 8 patients received high doses of steroids alone; 6(75%) patients in this group showed significant clinical and laboratory improvement while renal function deteriorated in the other 2(25%) Complications included herpes zoster in 2 that received IVCY, AVN in 2 patients that received steroids alone. Renal biopsy was repeated in 3 patients eighteen months after onset of IVCYand renal histology did not show any changes from baseline. WHO Class (n) Stable Creatinine Double Creatinine. End stage renal failure. N=15 (71.5%) N=2 (9.5%) N = 4 (19%) 21 IVCY STD IVCY STD IVCY STD IV 7 1 3 - - 2 1 Va /V b/ Vd 14 8 3 1 1 1 - Conclusion: Treatment of Lupus nephritis with IVCY and steroids stabilizes renal function in the majority of patients. However renal biopsy findings suggest that treatment does not alter the natural course of the disease.