Intravenous immunoglobulin treatment of lupus nephritis*

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Abstract

Objective:

To evaluate the clinical response of treatment-resistant membranousand membranoproliferative lupus nephritis to intravenous immunoglobulin (IVIg).

Methods:

Seven lupus nephritis patients who failed to respond to at leastprednisone 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 ormembranoproliferative lupus nephritis. Future studies should concentrate on determining the preferred treatment protocol of IVIg for the various classes of lupus nephritis.

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    *

    Supported by the Isaac and the Late Rene Razim Grant for research in autoimmunity

    1

    Lecturer, Department ofMedicine “B” and theResearch Unit of Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, and Sackler Faculty of Medicine, Tel-Aviv University, Israel

    2

    Department of Medicine “B” and the Research Unit of Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, and Sackler Faculty of Medicine, Tel-Aviv University, Israel

    3

    Lecturer, Department of Medicine “B” and the Research Unit of Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, and Sackler Faculty of Medicine, Tel-Aviv University, Israel

    4

    Professor of Medicine, Research Unit of RheumaticDiseases, Piestany, Slovakia

    5

    AttendingPhysician, Research Unit of Rheumatic Diseases, Piestany, Slovakia

    6

    Peter Poprac, MD, PhD: Attending Physician, Research Unit of Rheumatic Diseases, Piestany, Slovakia

    7

    Senior Lecturer, Rheumatology Unit, ShebaMedical Center, Tel-Hashomer and Sackler Faculty of Medicine, Tel-Aviv University, Israel

    8

    Professorof Medicine, Clinical Trial Consultant Lucca, Italy

    9

    Professor ofMedicine, Department of Medicine “B” and the Research Unit of Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, and Sackler Faculty of Medicine, Tel-Aviv University, Israel

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