title: Two cases demonstrating thalidomide's efficacy in refractory lupus nephritis.
abstract: Renal involvement in systemic lupus erythematosus (SLE) is common and has been associated with an increased risk of mortality [1]. Early diagnosis is imperative to control proteinuria and prevent the progression to end-stage renal disease. Standard induction therapies include cyclophosphamide (CYC) and mycophenolate mofetil (MMF); however, it has been estimated that approximately 30% of patients are refractory to these standard treatments after 1 year [2]. We present two cases of patients diagnosed with lupus nephritis (LN) who demonstrated persistent proteinuria while on standard treatments that markedly improved after addition of thalidomide (THD). A literature review was performed indicating that THD use with prednisolone (PL) was more efficacious than MMF with PL in resolving lupus nephritis in a mouse model. Thalidomide, which was well tolerated, was associated with a reduction in the protein-to-creatinine ratio with sustained results in both of our patient cases. These cases suggest more clinical data is needed to explore the potential utility of thalidomide in the treatment of LN.
authors.affiliation: Department of Internal Medicine, Morsani College of Medicine, University of South Florida, 17 Davis Blvd., Suite 308, Tampa, FL, 33606, USA.
authors.forename: Rita
authors.initials: R
authors.lastname: Raturi
authors.affiliation: Department of Internal Medicine, Morsani College of Medicine, University of South Florida, 17 Davis Blvd., Suite 308, Tampa, FL, 33606, USA.
authors.forename: Avani A
authors.initials: AA
authors.lastname: Patel
authors.affiliation: Morsani College of Medicine, University of South Florida, 13220 USF Laurel Drive, MDC 81, Tampa, FL, 33612, USA. jocarter@health.usf.edu.
authors.forename: John D
authors.initials: JD
authors.lastname: Carter
mesh_terms: D000293:Adolescent; D000328:Adult; D003622:Dapsone / Q000627:therapeutic use; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008181:Lupus Nephritis / Q000188:drug therapy*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D009173:Mycophenolic Acid / Q000627:therapeutic use; D013792:Thalidomide / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D013792:Thalidomide; D003622:Dapsone; D009173:Mycophenolic Acid; D008727:Methotrexate
keywords: Lupus; Lupus nephritis; Proteinuria; Thalidomide