Effect of cyclosporin A on patients with lupus nephritis: a review of the literature

Abstract

Background. Steroids have been used for patients with some histologic groups of lupus nephritis with/without nephrotic-range proteinuria. However, many patients exhibit steroid-resistance, steroid-dependence, and/or frequent relapse, and there are many adverse effects. Recently, cyclosporin (CsA) has been reported to be effective for steroid-resistant nephrotic syndrome; however, with high-dose use, it produces specific adverse effects, especially nephrotoxicity. Here, we report results with the administration of low-dose CsA to patients with systemic lupus erythematosus (SLE).

Methods. We treated three patients with steroid-resistant lupus nephritis with CsA (80–100 ng/ml blood trough level) for 6 months, and investigated the effect of CsA on lupus nephritis and SLE activity.

Results. Mean pretreatment and posttreatment values for both 24-h urine protein excretion and total protein improved after treatment. Furthermore, SLE disease activity index scores, and levels of complements, anti-unclear antibody (ANA), anti-DNA antibody, and immune complexes in the three patients also improved.

Conclusions. Our results support the idea that low-dose CsA is effective for nephrotic-range proteinuria caused by lupus nephritis, and show that this treatment may decrease SLE activity, without producing severe adverse effects.