Kidney involvement is common in systemic lupus erythematosus, occurring
in up to 60% of affected adults during the course of their disease. Diffuse
proliferative lupus nephritis (World Health Organization class IV), the most
ominous variant, has traditionally been treated with cyclophosphamide and
glucocorticoids. With cyclophosphamide, women of childbearing potential must
weigh the risks of sustained amenorrhea, infertility, increased susceptibility
to infection, bone marrow suppression, hemorrhagic cystitis, and malignancy
against the benefits of better disease control compared with glucocorticoids
alone. Because of the host of adverse effects associated with cyclophosphamide,
alternative approaches to the treatment of lupus nephritis are desirable.
A 31-year-old woman developed class IV lupus nephritis in the postpartum period.
Seeking to preserve fertility and avoid other known toxicities of cyclophosphamide,
she chose to undergo therapy with mycophenolate mofetil. In the treatment
of severe lupus nephritis, mycophenolate mofetil has emerged as an alternative
to cyclophosphamide, offering a major advance in the therapy of lupus nephritis.
A, Hyperlobulated glomerulus with global involvement with endocapillary
and mesangial hypercellularity with matrix expansion (white arrowheads) and
wireloop lesions (black arrowheads). B, Glomerulus with global endocapillary
proliferation, leukocyte influx, mesangial expansion, and crescent formation
(hematoxylin-eosin stain; original magnification x 400).
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