title: A case of lupus nephritis improved after appropriately adjusting the dosage of mizoribine.
abstract: A 29-year-old male presenting nephrotic syndrome and facial skin erythema was admitted to our hospital in September of 2000. We diagnosed him as having systemic lupus erythematosus (SLE) accompanied by lupus nephritis (WHO class V). The disease activity had decreased after treatment with methylprednisolone (m-PSL) pulse therapy, which was followed by oral PSL. Thereafter, when tapering the dosage from 60 to 30 mg/day, the lupus nephritis flared up and he was re-hospitalized in February of 2001. After successful retreatment with m-PSL pulse therapy followed by the tapering of the dosage from 60 to 30 mg/day, we used mizoribine (MZR) as a combination therapy. The lupus nephritis flared up again after tapering down to 17.5 mg/day of PSL. Then, we changed the MZR dosage from 150 mg/day in three divided daily doses to 200 mg/day in two divided daily doses. This modification increased the peak blood concentration (Cmax) of MZR from 0.63 to 1.55 microg/ml. At present, we have been able to successfully taper the dosage to 7.5 mg/day of oral PSL and the patient has achieved a state of remission without any side effects. Monitoring of the serum concentration of MZR is thus considered to be important for achieving effective therapy of SLE, especially for steroid-resistant lupus nephritis. If the serum concentration of MZR does not reach an effective level, then the dosage of MZR should be adjusted appropriately in order to maintain an adequate serum concentration of MZR.
authors.affiliation: Division of Rheumatology and Allergology, Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Tsubouchi
authors.forename: Wataru
authors.initials: W
authors.lastname: Fukuda
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kawahito
authors.forename: Masataka
authors.initials: M
authors.lastname: Kohno
authors.forename: Makoto
authors.initials: M
authors.lastname: Wada
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Ishino
authors.forename: Masahide
authors.initials: M
authors.lastname: Hamaguchi
authors.forename: Aihiro
authors.initials: A
authors.lastname: Yamamoto
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Kadoya
authors.forename: Mikiko
authors.initials: M
authors.lastname: Niimi
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Yoshikawa
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000032:analysis; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring; D004359:Drug Therapy, Combination; D006801:Humans; D008181:Lupus Nephritis / Q000188:drug therapy*; D008297:Male; D009404:Nephrotic Syndrome / Q000188:drug therapy* / Q000209:etiology; D011239:Prednisolone / Q000008:administration & dosage; D012263:Ribonucleosides / Q000008:administration & dosage* / Q000032:analysis
chemical_list: D000893:Anti-Inflammatory Agents; D012263:Ribonucleosides; C010052:mizoribine; D011239:Prednisolone