Successful Discontinuation of Glucocorticoid Treatment after Administration of a Calcineurin Inhibitor for Nephrotic Syndrome in a Patient with Lupus Nephritis

Intern Med. 2023 Apr 1;62(7):1037-1041. doi: 10.2169/internalmedicine.0160-22. Epub 2022 Sep 6.

Abstract

Systemic lupus erythematosus was diagnosed in a patient at 43 years old. When proteinuria recurred at 57 years old, the first kidney biopsy was performed, and class IV-G (A) +V lupus nephritis was diagnosed. The prednisolone dose was increased to 40 mg/day, and cyclosporine A was introduced. After 1 year, proteinuria had decreased to 0.1 g/day. Prednisolone was discontinued three years later, and cyclosporine A was continued. Thereafter, proteinuria did not reoccur. At 67 years old, a second kidney biopsy showed complete remission of lupus nephritis. Cyclosporine A enabled permanent discontinuation of glucocorticoids in a patient with lupus nephritis.

Keywords: calcineurin inhibitor; glucocorticoid; lupus nephritis; systemic lupus erythematosus.

MeSH terms

  • Adult
  • Aged
  • Calcineurin Inhibitors / therapeutic use
  • Cyclosporine / therapeutic use
  • Glucocorticoids / therapeutic use
  • Humans
  • Immunosuppressive Agents / adverse effects
  • Lupus Erythematosus, Systemic* / drug therapy
  • Lupus Nephritis* / complications
  • Lupus Nephritis* / drug therapy
  • Middle Aged
  • Nephrotic Syndrome* / complications
  • Nephrotic Syndrome* / drug therapy
  • Prednisolone / therapeutic use
  • Proteinuria / diagnosis
  • Proteinuria / drug therapy
  • Proteinuria / etiology

Substances

  • Glucocorticoids
  • Calcineurin Inhibitors
  • Cyclosporine
  • Prednisolone
  • Immunosuppressive Agents