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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
Originalien

Summary

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 

Abbreviations

CyA

Cyclosporin

MTX

Methotrexate

NSAID

Nonsteroidal antiinflammatory drugs

RA

Rheumatoid arthritis

SLE

Systemic lupus erythematosus

TFA index

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

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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

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