Microsoft Word - NEF236BF

D.M. Grekas, Ass. Prof. in Nephrology, University Hospital AHEPA, Thessaloniki 546 37 (Greece) Dear Sir, The efficacy of steroids and immunosuppressive agents in the treatment of idiopathic or systemic glomeru-lar disease remains controversial. The use of corticoste-roids in the treatment of lupus nephritis is now standard, even though there is no controlled evidence that survival or morbidity have really improved [1]. Whether the addition of cytotoxic agents improves survival and morbidity is more controversial [2]. Cyclophosphamide is a cytotoxic immunosuppressive and anticancer drug that has been used to treat a large variety of human disorders. Since cyclophosphamide can suppress immune responses mediated by both B and T cells, many physicians have turned to this drug as a last resort for patients with various nonmalignant inflammatory diseases. Daily cyclophosphamide treatment puts the patient at a continuous risk with regard to bladder complications, infections and chromosomal abnormalities which may lead to lymphoma or leukemia. In contrast, treatment with intermittent boluses of cyclophosphamide limits the risk of such complications. These data, based on animal studies as well as on studies of patients with lupus erythematosus, suggest that it may be possible to improve the current forms of therapy [3]. To our knowledge, cyclophosphamide pulse therapy has not yet been tested in patients with idiopathic membranous nephropathy (IMG). We have therefore tried this treatment in 2 male patients with IMG and nephrotic syndrome. At first, both patients were given oral 1–2 mg/kg body weight methylprednisolone daily. The dosage was then slowly reduced during the next 2 months. Due to the absence of any positive response, the patients were also given pulse methylprednisolone treatment (1 g daily for 3–4 consecutive days). Both patients then developed resistance to steroid treatment, and we decided to continue the pulse therapy with 1 g cyclophosphamide per month. After 5–6 sessions of this treatment, the 2 Table I. Clinical and laboratory findings of 2 patients with IMG and nephrotic syndrome