[Morphologic transformation of renal lesions by steroid treatment and its therapeutic implication in a patient with lupus nephritis].
When we perform renal biopsy in patients with lupus nephritis (LN), we use the histopathological findings in glomerulus for the choice and dosage of steroid and immunosuppressive therapy. Recently, we experienced a case of LN who underwent three times of renal biopsy and had received various dosages of steroid. Our therapy resulted in her renal function deteriorated over 5 years. In detail, the patient was a 45-year-old female and the first renal biopsy was performed at the active stage of LN with nephrotic syndrome and serological activities. The biopsy specimen showed membranous LN accompanied by mesangial proliferation, necrosis, cellular crescents and intramembranous deposits. Thus, large dose of steroid including pulse therapy was given, and subsequently massive proteinuria and serological activities subsided gradually. However, 4.0 g of proteinuria per day remained in the patient. Accordingly, the second biopsy was done at one and half years later and it showed the regression to nearly pure membranous LN with thickening of glomerular basement membrane and only mild increment of mesangial matrix. Thus, she remained on 15 mg of daily prednisolone. Eventually, she progressed to 2.3 mg/dl of serum creatinine in renal function. The third biopsy was undertaken 5 years later and it showed sclerosing LN with tubular atrophy. Based upon these serial morphologic alterations in LN, we presumed that steroid treatment per se was not adequate for the control of this type of LN and new additional therapy including cytotoxic drugs is probably needed for the improvement of these glomerular lesions.
Saito
M
M
First Department of Internal Medicine, Kyorin University School of Medicine, Tokyo.
Nakabayashi
K
K
Maemura
C
C
Kitamoto
K
K
Nagasawa
T
T
D001706:Biopsy; D005260:Female; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000473:pathology*; D007678:Kidney Glomerulus / Q000187:drug effects / Q000473:pathology; D008181:Lupus Nephritis / Q000188:drug therapy* / Q000473:pathology; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use*
D011239:Prednisolone