Few studies describe the treatment of
membranous nephropathy associated with
systemic lupus erythematosus. Although
cyclosporine-A has been used to treat patients with the
nephrotic syndrome and also with systemic lupus, only a few of these patients have had lupus
membranous nephropathy. In this pilot study, we assessed the safety and efficacy of
cyclosporine in ten nephrotic patients with either pure membranous lupus nephropathy (seven patients) or membranous lupus nephropathy with superimposed mild proliferative lesions (three patients).
Cyclosporine (4-6 mg/kg/day) alone (2 patients), or in conjunction with low dose
corticosteroids (8 patients) was given for a period of up to 43 months. Six patients achieved a nadir
proteinuria of less than 1 gram daily, two patients decreased urinary
protein excretion to 1-2 grams daily, and the remaining two patients continued to excrete over 2 grams of
protein daily. All patients experienced symptomatic improvement of their
nephrotic syndrome and serum
creatinine was not significantly increased at the end of the study period. Three patients with superimposed mild proliferative lesions experienced renal and systemic lupus flares while on treatment requiring additional immunosuppressive therapy. Side-effects were minor except for transient rises in serum
creatinine in one patient and a case of
drug-related
hepatitis possibly caused by
cyclosporine. Repeat renal biopsies in five patients revealed a decrease in the lupus activity index and a rise in the chronicity index. There was an increase in the stage of the
membranous nephropathy on these repeat biopsies, but a reduction in the number of fresh deposits.(ABSTRACT TRUNCATED AT 250 WORDS)