THERAPEUTIC OPTIONS FOR CRITICALLY ILL PATIENTS SUFFERING FROM PROGRESSIVE LUPUS NEPHRITIS OF GOODPASTURES-SYNDROME

Systemic lupus erythematosus is a chronic disease with many clinical f eatures, while Goodpasture's syndrome usually becomes manifest with pr ogressive glomerulonephritis and pulmonary hemorrhage. Rapidly declini ng renal function and even pulmonary hemorrhage may be the common feat ure. Early and precise diagnosis is most important as it may provide g eneral prognostic information and serve as a guideline for initial the rapy. Immunosuppression with oral cyclophosphamide and high dose corti costeroids together with plasmapheresis is used in Goodpasture's syndr ome. Progressive lupus nephritis requires high dose corticosteroids to gether with i.v. pulses of cyclophosphamide for at least six months, f ollowed by maintanance immunosuppression. The benefits of therapy must always be weighed against the risks. Nevertheless, current therapy re mains less than optimal. A better understanding of the pathogenesis of systemic lupus erythrematosis (SLE) and Goodpasture's syndrome may pr ovide more specific information about the nature and the role of the i mmune response and thus lead to new treatment strategies.