A case of steroid-resistant lupus nephritis and successful treatment with chlorambucil

A 30-year-old housewife was admitted to the Kyushu University Hospital in December 1979, because of generalized edema and ascites. Six years before admission she was diagnosed as systemic lupus erythematosus by symptoms of Raynaud's phenomenon, polyarthralgia, photosensitivity and facial erythema. In 1975, at her first admission to this hospital, proteinuria was found and histological examination of renal specimen revealed minimal change. Administration of corticosteroid hormone relieved these symptoms. In 1976, at her second admission, she was pregnant and manifested nephrotic syndrome. After the delivery profuse proteinuria was improved by the increased dose of corticosteroid. However, nephrotic syndrome relapsed sometimes, ascites and peripheral edema were prominent. On this admission, nephrotic syndrome did not respond to large dose of prednisolone for three months. The second renal histological specimen showed diffuse proliferative lupus nephritis, and then the patient was treated with chlorambucil, 6 mg per day combined with prednisolone. The level of serum albumin was elevated several weeks after the combination therapy. Generalized edema and ascites lessened gradually and she had been well with this maintenance therapy. No side effects were seen except for transient leukopenia, which were recovered soon after the discontinuance of chlorambucil. As described above, chlorambucil was one of the useful drug for the treatment of steroid-resistant lupus nephritis.