title: Cyclosporine A in treatment of membranous lupus nephropathy.
abstract: OBJECTIVE
  To investigate retrospectively the efficacy of cyclosporine A (CsA) in the treatment of membranous lupus nephropathy (MLN).
  
  
  METHODS
  Twenty-four patients with systemic lupus erythematosus (SLE) and biopsy-proven MLN were treated with CsA in combination with prednisone. CsA was given at a starting dosage of 5 mg x kg(-1) x d(-1) for 3 months, with a 1 mg x kg(-1) x d(-1) reduction every month and then maintained at a dosage of 2 mg x kg(-1) x d(-1). The dosage of oral prednisone differed from person to person according to levels of extra-renal activity. Clinical efficacy and adverse reactions were retrospectively analyzed. Complete remission was defined as having a urinary proteinuria level (Upr) of < 0.4 g/d, and normal serum albumin and serum creatinine (SCr) levels, without SLE activity. Partial remission was defined as having a UPr decrement > 50% of baseline value and a serum albumin value of 30 - 35 g/L, without SLE activity. No response was defined as having a Upr decrement < 50% of baseline value and > 2.0 g/d, or as a deterioration of renal function, or as having active SLE.
  
  
  RESULTS
  One patient could no longer undergo follow-up, and the other 23 patients were treated with CsA and followed up for 6 - 36 months (mean 16.8 +/- 8.4 months). The mean starting dosage of CsA was 4.7 +/- 0.5) mg x kg(-1) x d(-1) and the trough level of the whole blood CsA was 248 +/- 110) micro g/L. Twelve patients (52.2%) achieved complete remission, 10 patients (43.3%) achieved partial remission after CsA treatment, and one patient showed no response. At different CsA treatment timepoint, the complete remission rates were 17.4% (3rd month), 21.7% (6th month), 40% (12th month), 88.9% (18th month) and 100% (24th month) respectively. SCr elevation, when within a normal limit was not observed in most patients during early CsA administration, and at the end of the follow-up all the patients had a normal SCr. Relapse occurred in 33.3% of the patients after withdrawing CsA for 4 - 24 months. No chronic CsA renal toxicity was observed in 4 patients who had a repeat renal biopsy after CsA treatment for 6 - 24 months.
  
  
  CONCLUSIONS
  CsA could be regarded as an effective therapy for patients with membranous lupus nephropathy, but its adverse effects, especially its nephrotoxicity, should be carefully monitored during CsA treatment.
authors.affiliation: Institute of Nephrology, Jinling Hospital, Clinical School of Medicine, Nanjing University, Nanjing 210002, China. huwx64@medmail.com
authors.forename: Weixin
authors.initials: W
authors.lastname: Hu
authors.forename: Zhihong
authors.initials: Z
authors.lastname: Liu
authors.forename: Shuqiong
authors.initials: S
authors.lastname: Shen
authors.forename: Shijun
authors.initials: S
authors.lastname: Li
authors.forename: Xiaodan
authors.initials: X
authors.lastname: Yao
authors.forename: Huiping
authors.initials: H
authors.lastname: Chen
authors.forename: Leishi
authors.initials: L
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D016572:Cyclosporine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000188:drug therapy*; D006801:Humans; D008181:Lupus Nephritis / Q000188:drug therapy*; D008297:Male; D011241:Prednisone / Q000008:administration & dosage; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D016572:Cyclosporine; D011241:Prednisone