Plasma exchange in the treatment of lupus nephritis

Seven women with severe Systemic Lupus Erythematosus Nephritis were treated with Plasma Exchange, without any additional therapy with cytotoxic agents. All patients had failed to respond to high doses of corticosteroids and, in 3 cases, to 6-methylprednisolone pulses. In 4 patients the indication for plasma exchange treatment was a rapid deterioration of renal function, and in the others a need to better control symptoms without using toxic corticosteroid dosages. The total number of plasma exchange sessions ranged from 14 to 57 depending on the patient. After PE treatment, serum creatinine values significantly decreased in all 4 patients with rapidly developing, nephritis while in the others it remained unchanged. No major side effects were recorded and no relapse of renal disease occurred whenever Plasma Exchange treatment was gradually tapered or discontinued. These data suggest that prolonged Plasma Exchange treatment without the concomitant administration of cytotoxic agents may be effective in the treatment of steroid resistant severe lupus nephritis.