Improvement in Steroid and Immunosuppressive Drug Resistant Lupus nephritis by Intravenous Prostaglandin E1Therapy

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Abstract
From January 1986 to December 1988, 8 patients with lupus nephritis did not respond to the administration of two courses of methylprednisolone pulse therapy and cyclophosphamide treatment for 56 days. These cases then received intravenous prostaglandin E1 (PGE1) for 3 weeks. All of them had a good response with decreased proteinuria and azotemia; serum C3 and C4 levels and creatinine clearance also increased. Both OKT4+ and OKT8+ cells increased, and the OKT4/OKT8 ratio was almost normal. The macrophage functions included increased production of interleukin 1 and γ-interferon. The capacity to synthesize immunoglobulin after pokeweed mitogen stimulation was reduced, the circulating immune complexes lowered, and glomerular IgG deposits decreased in the two class IV follow-up biopsy cases after PGE1 therapy. These clinical improvements after PGE1 therapy are probably related to the modulation of macrophage T-B cell interaction, enhancement of reticuloendothelial system function, and increased glomerular capillary flow.