Intravenous immunoglobulin treatment of lupus nephritis.
OBJECTIVE
To evaluate the clinical response of treatment-resistant membranous and membranoproliferative lupus nephritis to intravenous immunoglobulin (IVIg).


METHODS
Seven lupus nephritis patients who failed to respond to at least prednisone and cyclophosphamide were studied. A kidney biopsy showing either membranous or membranoproliferative glomerulonephritis was available in six patients. They were treated with six courses (patients 1 and 2) or 1 or 2 courses (patients 3 through 7) of high-dose IVIg. For patients 3 through 7, the plasma levels of albumin, total cholesterol, urea, creatinine, dsDNA antibody titers, and daily proteinuria were measured just before the IVIg therapy, immediately on completion, and 6 months later.


RESULTS
All seven patients had a beneficial response to IVIg. In patient 1, decrease in proteinuria was evident 2 weeks after IVIg was started, nephrotic syndrome gradually disappeared, and she had no proteinuria in 3 years' follow-up. Decline in proteinuria was evident in patient 2 after the 4th IVIg course, but proteinuria reached the pretreatment level 4 months after the therapy ended. In patients 3 through 7, the mean daily proteinuria before IVIg (5.3 +/- 2.1 g) decreased after 1 or 2 IVIg courses (3.3 +/- 1.4 g), and further decreased when measured 6 months later (2.1 +/- 1.3 g). Similarly, the plasma cholesterol level decreased while the plasma albumin level increased after IVIg.


CONCLUSIONS
IVIg might be effective in treatment-resistant membranous or membranoproliferative lupus nephritis. Future studies should concentrate on determining the preferred treatment protocol of IVIg for the various classes of lupus nephritis.
Levy
Y
Y
Department of Medicine B, Sheba Medical Center, Tel-Hashomer, Israel.
Sherer
Y
Y
George
J
J
Rovensky
J
J
Lukac
J
J
Rauova
L
L
Poprac
P
P
Langevitz
P
P
Fabbrizzi
F
F
Shoenfeld
Y
Y
D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D003520:Cyclophosphamide / Q000627:therapeutic use; D004351:Drug Resistance; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007677:Kidney Function Tests; D008181:Lupus Nephritis / Q000097:blood / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000097:blood / Q000188:drug therapy; D011241:Prednisone / Q000627:therapeutic use; D011507:Proteinuria / Q000097:blood / Q000188:drug therapy; D016896:Treatment Outcome
D015415:Biomarkers; D016756:Immunoglobulins, Intravenous; D003520:Cyclophosphamide; D011241:Prednisone