The role of plasmapheresis in the treatment of severe lupus nephritis: a case report.

There is still controversy about the efficacy of plasma exchange in the treatment of severe lupus nephritis. Some studies have reported no beneficial effect with plasma exchange, while others claim its usefulness when used in combination ("synchronization") with immunosuppressive drugs, particularly intravenous (i.v.) pulse doses of cyclophosphamide. We report here a 13 year old girl who presented twice with severe exacerbation of lupus nephritis (WHO class IV) leading to acute renal failure (ARF) necessitating dialysis, and who on both occasions responded well to i.v. pulse doses of cyclophosphamide and methylprednisolone plus plasma exchange. The second episode of ARF had occurred in spite of the patient being on maintenance therapy with prednisolone and i.v. cyclophosphamide. The course in this patient supports the view that the addition of plasma exchange to i.v. pulse cyclophosphamide might be effective in patients with severe lupus nephritis unresponsive to immunosuppressive drugs alone.