Steroid Monotherapy for the Treatment for Pure Membranous Lupus Nephritis: A Case Series of 5 Patients and Review of the Literature
Journal Title: Archives of Clinical Nephrology - Year 2017, Vol 3, Issue 1
Abstract
Introduction: The benefit of combination immunosuppression versus steroid monotherapy in pure membranous lupus nephritis (MLN) remains unclear. Steroid monotherapy could potentially reduce exposure to excessive immunosuppression in patients achieving remission with this strategy. The aim of this study was to define patient characteristics and outcomes in MLN treated with steroid monotherapy. Method: A retrospective, observational study identified all biopsy-proven pure MLN cases followed since 1990 in a single center. Demographic, clinical and histological data were gathered for patients treated with daily steroid monotherapy. The primary outcome of interest was the reduction in proteinuria, reported as complete remission (CR), partial remission (PR) or no response. Results: We identified 5 patients who received steroid monotherapy for pure MLN. The patients were 80% female with preserved renal function and little, if any, evidence of chronic interstitial fibrosis on biopsy. The mean follow-up period was 79.4±57.6 months. All cases achieved a clinical remission (CR in two patients and PR in 3 patients). The three patients who achieved only partial remission had a relapse during follow-up, which were successfully treated by addition of further immunosuppression, whereas the two patients who achieved CR did not experience a relapse. The mean estimated GFR was similar at baseline and the latest follow-up, 117±20.7ml/min/1.73m2 vs 111±11.3ml/min/1.73m2, respectively (p=0.61). Conclusion: Daily steroid monotherapy may be an appropriate first-line treatment for pure MLN. Larger, prospective, trials are needed to validate this strategy and identify those patients who are most likely to benefit.
Authors and Affiliations
Ward Frank, Alkhowaiter Mohammad, Bargman Joanne M
Keywords
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- DOI 10.17352/acn.000022
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