title: Successful treatment of class IV+V lupus nephritis with combination therapy of high-dose corticosteroids, tacrolimus and intravenous cyclophosphamide.
abstract: A substantial number of patients with lupus nephritis (LN) are refractory to conventional glucocorticoid (GC) treatment. Although many of these patients respond to immunosuppressive drugs such as intravenous cyclophosphamide (IVCY), azathioprine (AZA), mizoribine, tacrolimus, cyclosporine A (CSA) and mycofenolate mofetil (MMF), some remain refractory to such therapies. Recent studies of multi-target therapies have reported effective outcomes for immunosuppression following renal transplantation and refractory LN when therapy consists of two or more immunosuppressive drugs with different mechanisms of action. We herein report a case of LN unresponsive to IVCY that was successfully treated with the addition of tacrolimus and discuss the usefulness of multi-target therapy for LN.
authors.affiliation: Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University, Japan.
authors.forename: Takahiko
authors.initials: T
authors.lastname: Kurasawa
authors.forename: Hayato
authors.initials: H
authors.lastname: Nagasawa
authors.forename: Eiko
authors.initials: E
authors.lastname: Nishi
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Takei
authors.forename: Ayumi
authors.initials: A
authors.lastname: Okuyama
authors.forename: Tsuneo
authors.initials: T
authors.lastname: Kondo
authors.forename: Koji
authors.initials: K
authors.lastname: Nishimura
authors.forename: Ryota
authors.initials: R
authors.lastname: Sakai
authors.forename: Akiko
authors.initials: A
authors.lastname: Shibata
authors.forename: Kentaro
authors.initials: K
authors.lastname: Chino
authors.forename: Hiroe
authors.initials: H
authors.lastname: Ogawa
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Ito
authors.forename: Koichi
authors.initials: K
authors.lastname: Amano
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kato
mesh_terms: D000293:Adolescent; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001713:Biphenyl Compounds / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000627:therapeutic use*; D016572:Cyclosporine / Q000008:administration & dosage / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006977:Hypertension, Renal / Q000188:drug therapy / Q000209:etiology; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D000077405:Irbesartan; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000175:diagnosis; D008181:Lupus Nephritis / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D009404:Nephrotic Syndrome / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D020551:Pulse Therapy, Drug; D012008:Recurrence; D012263:Ribonucleosides / Q000008:administration & dosage / Q000627:therapeutic use; D012720:Severity of Illness Index; D016559:Tacrolimus / Q000008:administration & dosage / Q000627:therapeutic use*; D013777:Tetrazoles / Q000627:therapeutic use
chemical_list: D000959:Antihypertensive Agents; D001713:Biphenyl Compounds; D007166:Immunosuppressive Agents; D012263:Ribonucleosides; D013777:Tetrazoles; C010052:mizoribine; D016572:Cyclosporine; D003520:Cyclophosphamide; D011239:Prednisolone; D000077405:Irbesartan; D016559:Tacrolimus