Successful use of intravenous immunoglobulin in the treatment of resistant lupus nephritis

• Autor(a) principal: Cotovio,Patrícia
• Data de Publicação: 2013
• Outros Autores: Silva,Cristina, Afonso,Nuno, Costa,Fátima, Carreira,Armando, Campos,Mário
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692013000100007
• topic: Immunosuppression; intravenous immunoglobulin; lupus nephritis

Background: Renal involvement in systemic lupus erythematosus is a major factor of morbidity/mortality and a significant prognostic determinant. Despite the high rates of remission with current immunosuppressive therapies, management of refractory lupus nephritis is still cumbersome. In these cases, intravenous immunoglobulin may be a suitable option, regardless of the scarcity of experience with long-term use. Case report: We present the case of a 35-year-old female with a diagnosis of systemic lupus erythematosus since 1999, at the age of 23. In 2002, due to a nephrotic syndrome, a kidney biopsy was performed, which revealed WHO class IV lupus nephritis. She underwent immunosuppression with prednisolone and cyclophosphamide, with subsequent conversion to azathioprine. Proteinuria decreased to subnephrotic levels. In 2005, a nephrotic syndrome relapse occurred and kidney biopsy was repeated, with a similar result. After conversion from azathioprine to mycophenolate mofetil, proteinuria decreased to subnephrotic levels. At the end of 2006, a nephrotic syndrome relapse accompanied by arthralgia, azotaemia, leukopaenia and anaemia led to a third biopsy. The diagnosis was again the same, with no sclerotic lesions. Intravenous immunoglobulin was initiated in a protocol of monthly courses of 400mg/Kg/day during 5 consecutive days, maintaining prednisolone and mycophenolate mofetil. She achieved partial and complete remission after the third and tenth courses, respectively. The treatment scheme of immunoglobulin became quarterly from the second year until today. In 2010, she became pregnant and mycophenolic acid was replaced by azathioprine.In the last trimester of pregnancy proteinuria worsened, thus delivery was induced at the 32nd week. Nowadays the patient is in complete remission of nephritis, without extrarenal manifestations of lupus and no adverse effects of intravenous immunoglobulin. Conclusion: Intravenous immunoglobulin has been effectively used in a broad spectrum of lupus manifestations. As this case illustrates, it may be an option in the treatment of lupus nephritis resistant to conventional immunosuppressive therapy. Its long-term use appears to be safe.