Successful treatment of severe crescentic lupus nephritis by multi-target therapy using tacrolimus and mycophenolate mofetil

Abstract

Treatment of severe lupus nephritis (LN) has been controversial, and according to recent guidelines and recommendations, cyclophosphamide still remains a first-line therapy. Herein, we present the case of a 37-year-old female patient who developed rapidly progressive glomerulonephritis, which was histologically diagnosed as class IV + V LN, with a large number of cellular to fibrocellular crescents (62 % of glomeruli). Although the patient was considered to have the most severe form of LN, complete remission was achieved within 6 months by multi-target therapy using tacrolimus and mycophenolate mofetil combined with methylprednisolone pulse therapy. Our experience suggests that multi-target therapy could be a potential treatment option for patients with severe crescentic LN.

Keywords: Crescentic lupus nephritis; Lupus nephritis; Multi-target therapy; Mycophenolate mofetil; Tacrolimus.

Fig. 1

Renal pathology. a, b Light-microscopic findings showing severe endocapillary proliferation and crescents (indicated by arrows, a periodic acid-Schiff staining, original magnification ×100, b hematoxylin–eosin staining ×400). c Immunofluorescence staining for C1q. Fine granular stainings are observed, mainly along the glomerular capillary walls (original magnification ×400). d, e Electron-microscopic findings showing both subepithelial (indicated by arrowheads) and subendothelial deposits (indicated by arrows) (original magnification, d ×2,500, e ×15,000)

Fig. 2

Clinical course after admission. mPSL methylprednisolone, PSL prednisolone, TAC tacrolimus, MMF mycophenolate mofetil, AZA azathioprine, GCV ganciclovir, CMV cytomegalovirus, LN lupus nephritis, U-Pro urinary protein, anti-dsDNA anti-double-strand DNA antibody