Effect of cyclophosphamide pulse therapy in a patient with intractable lupus nephritis

A 32-year-old female was suffering from intractable lupus nephritis (LN). Prednisolone at 30 mg per day had been prescribed for two months because of massive proteinuria and edema. After that, anasarca and orthopnea were induced, and hypoproteinemia, hypercholesteremia, and anti-cardiolipin antibody were observed. Prednisolone at a dose of 60 mg per day was necessary. However, there was no improvement of the nephrotic state and renal pathological changes shown as diffuse proliferative lupus nephritis were followed by moderate crescent formation as determined by serial needle biopsy. Cyclophosphamide (CYP) pulse therapy was started and marked improvement of LN was obtained clinically and serologically without significant adverse effects.