[Synchronizing therapy with plasmapheresis and cyclophosphamide in rapidly progressing systemic lupus erythematosis with kidney involvement]

Abstract

12 patients with rapidly progressive systemic lupus erythematosus (SLE) combined with renal failure were treated for 6 months according to the following scheme: 3 consecutive procedures of plasmapheresis (60 ml/kg x 3), 3 consecutive pulse doses of cyclophosphamide (400 mg/m2 x 3), 3 prednisolone infusions (2 mg/kg x 3), oral cyclophosphamide (100-250 mg/day) and prednisolone (0.5 mg/kg with subsequent dose reduction). Dose of the drugs was controlled by blood leukocyte count and creatinine clearance. The patients were included in the trial in the preset time. All the patients had active SLE (33.5 +/- 2.7 U according to SLAM). 75, 25, 58.3, 33.4, 8.3% of patients had mixed, nephrotic, mesangiocapillary, mesangioproliferative, membraneous nephritis, respectively. 26 weeks of the treatment produced a response in 83.3% of the patients. The disease activity lowered to 12.8 +/- 2.9 U. Four-year survival reached 81%. Cytopenia developed in 25% of patients, deep hemopoiesis depression was not observed. Septic candidiasis arose in one woman on the third year of the follow-up. Clinical validity of the above method is stated in severe SLE.