Although the combination of
corticosteroids and intermittent pulse doses of
cyclophosphamide has considerably improved the prognosis of
lupus nephritis, there are still some unanswered questions about this regimen, in particular its use in pregnancy. As
cyclosporine appeared to be effective in experimental models of
lupus nephritis, some studies have been performed using this
drug in patients with
lupus nephritis. However, there was no mention of pregnancy in these patients. In view of the large experience with
cyclosporine during pregnancy in renal transplant recipients and its established safety concerning teratogenicity, we decided to treat 5 young female patients having
lupus nephritis with
cyclosporine in combination with low-dose
prednisone. Two of these patients were pregnant and both had successful delivery. During the follow-up period of 7-35 months there were no signs of flare-up of the
lupus nephritis, except in one case where the patient accidentally discontinued the medication. In a second patient there was a slight increase of the serum
creatinine level. Otherwise, the renal and immunological parameters improved or remained stable during the observation period.
Hypertension developed in 3 cases. These preliminary results support the further evaluation of
cyclosporine as an alternative to
cyclophosphamide in the treatment of
lupus nephritis, especially in young female patients with pregnancy or at high risk for pregnancy.