Response to Chlorambucil

\s=b\ Nephrotic syndrome associated with mesangial lupus nephritis developed in a young woman. The heavy proteinuria exhibited a striking steroid-dependent course during a three\x=req-\ year period of time, with ten relapses occurring whenever attempts were made to withdraw prednisone therapy. A prolonged remission was induced by the administration of chlorambucil. (Arch Intern Med 1984;144:2411-2412) "LTeavy proteinuria is common in systemic lupus erythe·*- *- matosus (SLE) and may produce the nephrotic syn¬ drome.13 This can improve with steroid use, but the pro¬ teinuria often lasts for months and may not disappear.2"4 Although some patients have a second or third bout of the nephrotic syndrome,2,6 to our knowledge, a relapsing, steroid-dependent course has not been reported. We describe a patient with mesangial lupus nephritis whose clinical course followed a pattern typical of lipoid nephrosis. It was characterized by recurrent episodes of nephrotic syndrome or heavy proteinuria, which were brought on by withdrawal of prednisone therapy and were promptly and completely responsive to reinstitution of corticosteroid treatment. The striking similarity between the clinical picture of this patient and that commonly observed in lipoid nephrosis was further accentuated by the long-lasting remission that followed the administration of chlorambucil.