Klinische Wochenschrift

, Volume 65, Issue 15, pp 727–736 | Cite as

Combined steroid-cyclosporin treatment of chronic autoimmune diseases

Clinical results and assessment of nephrotoxicity by renal biopsy
  • P. A. Miescher
  • H. Favre
  • F. Chatelanat
  • M. J. Mihatsch


Twenty-one patients suffering from different autoimmune diseases (14 from systemic lupus erythematosus, 4 from rheumatoid arthritis, one from Sjögren's syndrome, one from systemic hypersensitivity vasculitis, and one from diffuse proliferative glomerulonephritis) were treated with a combined immuno-suppressive regimen. Cyclosporin was given at a dose of 5 mg/kg/day together with steroids. In addition, the rheumatoid arthritis patients also received methotrexate. In all patients a kidney biopsy was performed after a treatment period of 17 to 42 months (mean duration 21.7 months). The cumulative cyclosporin dose at the time of biopsy varied from 1.071 to 4.587 mg/kg. Patients suffering from systemic lupus erythematosus and rheumatoid arthritis were assessed according to a scoring system set up for this purpose. The combined therapy proved useful in these patients as reflected in the diminution of the respective activity scores, improvement of kidney function, and diminution of proteinuria. Histological examination of the kidney biopsy specimens showed only minimal activity in patients with systemic lupus erythematosus. No unequivocal signs of renal toxicity could be detected. In the last group, the condition of the patient with Sjögren's syndrome was stabilized and the patient with systemic vasculitis improved clinically. Neither patient had signs of kidney lesions. The patient with diffuse proliferative glomerulonephritis, in whom kidney biopsy was performed before and after treatment, showed improvement of kidney function, diminution of proteinuria, and diminution of inflammatory activity within the kidney, and no signs of cyclosporin toxicity.

Key words

Systemic lupus erythematosus Rheumatoid arthritis Cyclosporin 







Nonsteroidal antiinflammatory drugs


Rheumatoid arthritis


Systemic lupus erythematosus

TFA index

Index of extent of tubular atrophy, intersitital fibrosis, and arteriolopathy


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Austin HA, Muenz LR, Joyce KM, Antonovych TT, Balow JE (1984) Diffuse proliferative lupus nephritis: identification of specific pathologic features affecting renal outcome. Kidney Int 25:698–695Google Scholar
  2. 2.
    Bennett WM, Pulliam JP (1983) Cyclosporin nephrotoxicity. Ann Intern Med 99:851–854Google Scholar
  3. 3.
    Berg KJ, Forre O, Bjerkhoel F, Amundsen E, Djoseland O, Rugstad HE, Westre B (1986) Side effects of cyclosporin A treatment in patients with rheumatoid arthritis. Kidney Int 29:1180–1187Google Scholar
  4. 4.
    Beris Ph, Burger A, Favre L, Riondel A, Miescher PA (1986) Adrenocortical responsiveness after discontinous corticosteroid therapy. Klin Wochenschr 64:70–75Google Scholar
  5. 5.
    Boitnott JK, Solez K (1984) The use of ranking in the statistical assessment of morphological data. In: Solez K, Whelton A (eds) Acute renal failure. Marcel Dekker, New York/BasleGoogle Scholar
  6. 6.
    Churg J, Sobin LH (1982) Renal disease. Classification and atlas of glomerular diseases. Igaku-Shoin, Tokyo, New York, pp 127–131Google Scholar
  7. 7.
    Favre H (1973) Détermination des fonctions rénales par la technique de l'injection unique. Analyse statistique de modèle bicompartimental proposé par Sapirstein. J Urol Nephrol 79:1007–1052Google Scholar
  8. 8.
    Favre H, Miescher PA (1984) Filtration fraction: an index of the renal disease activity in SLE patients. Davison AM, Guillon PJ (eds) Proc EDTA 21. Pitman, Bath, England 717–721Google Scholar
  9. 9.
    Izui S, Lambert PH, Miescher PA (1976) Determination of anti-DNA antibodies by a modified125I-labelled DNA-binding test. Elimination of non-specific binding of DNA to non-immunoglobulin basic proteins by using an anionic detergent. Clin Exp Immunol 26:423–430Google Scholar
  10. 10.
    Miescher PA (1986) Treatment of systemic lupus erythematosus. Springer Semin Immunopathol 9:271–282Google Scholar
  11. 11.
    Miescher PA (1986) 20 years of methotrexate in the treatment of autoimmune diseases. Rheumatology 9:46–50Google Scholar
  12. 12.
    Mihatsch MJ, Thiel G, Ryffel B (1985) Cyclosporin-associated nephropathy. In: Schindler R (ed) Cyclosporin in Autoimmune Diseases. 1st International Symposium, Basel. Springer-Verlag, Berlin, Heidelberg, pp 50–58Google Scholar
  13. 13.
    Mihatsch MJ, Bohman SO, von Graffenried B, Harrison WB (1986) First Interim Report of Renal Biopsy Registry of Patients with Autoimmune Diseases Treated with Cyclosporin, in pressGoogle Scholar
  14. 14.
    Myers BD, Ross J, Newton L, Leutscher J, Perlroth M (1984) Cyclosporin-associated chronic nephropathy. N Engl J Med 311:699–705Google Scholar
  15. 15.
    Nydegger UE, Achermann LM, Lambert PH, Miescher PA (1972) A simple automated method for complement estimation in a continuous flow system: J Immunol 109:910–913Google Scholar
  16. 16.
    Palestine AG, Austin HA, Balow JE, Antonovych TT, Sabnis SG, Preuss HG, Nussenblatt RB (1986) Renal histopathologic alterations in patients treated with cyclosporin for uveitis. N Engl J Med 314:1293–1297Google Scholar
  17. 17.
    Perrin LH, Lambert PH, Miescher PA (1975) Complement breakdown products in plasma from patients with membranoproliferative or other glomerulonephritis. J Clin Invest 56:165–176Google Scholar
  18. 18.
    Ritchie DM, Boyle JA, McInnes JM, Jasani MK, Dalakos TG, Grieveson P, Buchanan WW (1968) Clinical studies with an articular index for the assessment of joint tenderness in patients with rheumatoid arthritis. Q J Med 37:393–406 (1968)Google Scholar
  19. 19.
    Schindler R (ed) (1985) Cyclosporin in autoimmune diseases. Springer-Verlag, Berlin, HeidelbergGoogle Scholar
  20. 20.
    Svenson K, Bohman S-O, Hallgren R (1986) Renal interstitial fibrosis and vascular changes: occurrence in patients with autoimmune diseases treated with cyclosporin. Arch Intern Med 146:2007–2010Google Scholar
  21. 21.
    Zubler RH, Lange G, Lambert PH, Miescher PA (1976) Detection of immune complexes in unheated sera by a modified125I-C1q binding test. Effect of heating on the binding of C1q by immune complexes and application of the test to systemic lupus erythematosus. J Immunol 116:232–235Google Scholar

Copyright information

© Springer-Verlag 1987

Authors and Affiliations

  • P. A. Miescher
    • 1
  • H. Favre
    • 1
  • F. Chatelanat
    • 2
  • M. J. Mihatsch
    • 3
  1. 1.Department of MedicineUniversity of GenevaSwitzerland
  2. 2.Department of PathologyUniversity of GenevaSwitzerland
  3. 3.Department of PathologyUniversity of BasleSwitzerland

Personalised recommendations