[Mycophenolate mofetil for the treatment of lupus nephritis. The case of lupus nephritis--class IV according to WHO--treated with mycophenolate mofetil].

BACKGROUND: Lupus nephritis (LN) develops in almost 60% of patients with systemic lupus erythematosus. In its most severe proliferative forms, LN often leads to end-stage renal failure. Therapeutic regimens in severe lupus nephropathies, especially class IV according to WHO, are based on glucocorticosteroids (GCSs) administered together with cyclophosphamide (CPA) as the first-line drugs. New therapeutic options appeared once immunosuppressive properties of mycophenolic acid derivatives (mycophenolate mofetil) were documented. CASE REPORT: We describe a patient with LN class IV treated according to various immunosuppressive protocols adjusted to the degree of LN activity. The remission-inducing protocol based on intravenous pulses of GCSs and CPA resulted in regression of renal lesions but was associated with the risk of complications. Mycophenolate mofetil was found effective for maintenance therapy. CONCLUSION: The choice of therapy for patients with LN should be based on the severity of renal disease at the time of diagnosis and on the histopathology of the renal bioptate. Discrepancies obtain as to first-line drugs for severe forms of LN and duration of remission-inducing therapy.