Cyclosporine for lupus membranous nephritis: experience with ten patients and review of the literature

Objectives: The treatment of lupus membranous nephritis (LMN), a lupus subs et that carries a high morbidity, is unsatisfactory. We report our experien ce in treating LMN with the immunosuppressive drug cyclosporine (CYS). Methods: We treated 10 patients with systemic lupus erythematosus fulfillin g ACR criteria with CYS for at least 12 months and followed renal function, serologic activity and SLEDAI scores. Patient characteristics: 8 females, 2 males, 50% Caucasian, mean age 37.3 y (range 22-48), disease duration 108 .7 months (range 16-216), nephritis duration 35.5 months (range 12-59), dat e of biopsy to date of starting treatment 10.7 months (range 0-90). The pat ients were started on CYS with a mean dose of 3.8 mg/kg (range 2.2-6) and f ollowed for a mean duration of 24.8 months (range 12-59). A Medline search identified all patients with lupus who were given CYS or had LMN in article s from 1966-1999. Results: Proteinuria improved from a baseline mean of 5588 mg/24 h (range 2 712-11 055) to 1404 mg/24 h (range < 150-2652). Serum albumin increased fro m a baseline mean of 2.8 g/100 mi (range 1.31-3.8) to a mean of 3.9 g/100 m l (range 3-4.5) at last follow-up. There was no significant change in lupus activity as measured by SLEDAI. Nephrotoxicity was common as evidenced by an increase in serum creatinine but it returned to baseline with adjustment of the dose of CYS (20% decrease in the dose of CYS for a 20% increase in serum creatinine). More antihypertensive medications were required to contr ol the blood pressure in these ten patients at the end of the study compare d to the onset (total number = 13 versus 6). Conclusion: Proteinuria and serum albumin improved in all patients on CYS. A literature review is consistent with this. Controlled studies of the use of CYS for membranous lupus nephritis would be useful.