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The study carried out was at the Department of Nephrology, Military Medical Academy, over the period from 1996 to 2001. Different types of lupus nephritis were documented in 42 patients and were treated with standard therapeutic protocols (corticosteroids, the pulse dose of cyclophosphamide + corticosteroids) and cyclosporine in the target serum concentration of 100-120 ng/ml along with pronisone of 15-20 mg per day. The different degree of damaged renal function was observed. Renal biopsy was performed in 13 patients and in one patient rebiopsy was done. Twenty one patients were treated only with corticosteroids (remission in 23.8% of cases), with cyclophosphamide + corticosteroids 33 patients (remission in 42.4% of cases) and cyclosporine + corticosteroids 12 patients (remission in 91.7% of cases). The pulse therapy with cyclophosphamide in combination with corticosteroids, and cyclosporine in combination with lower doses of corticosteroids was statistically more successful in comparison with corticosteroids monotherapy (p < 0.01). Remission was found in 73.8% of patients, terminal renal weakness was observed in 7 patients, and fatal outcome in 4 patients. We recommend the pulse therapy of cyclophosphamide in combination with corticosteroids in the treatment of severe clinical forms of lupus nephritis, and in refractive forms cyclosporine in combination with low doses of corticosteroids.

Cyclosporin A (CyA) was administered at the Clinic of Nephrology, CCS, in treatment of 8 patients with steroid-resistant nephrotic syndrome (NS) caused by focal segmental glomerulosclerosis (FSG), Cyclophosphamide (CP) treatment was attempted in 6 of these cases, but without success. Prior to the onset of CyA therapy, CP treatment was interrupted, and the dose of prednisone was reduced to 0.4 mg/kg/48 h. CyA was applied in the initial dose of 5 mg/kg/bw/24h, and then adjusted so that CyA blood level was 80-120 ng/ml. Although CyA treatment caused proteinuric decrease in most of the patients (from 12.1 g/24 h to 8.2 g/24 h), complete NS remission was achieved in only one patient, the same as the incomplete one. The female patient with a positive response to CyA treatment behaved as "CyA-dependent" and each discontinuation of CyA therapy soon led to recurrent NS. Insignificant CyA effect on NS or renal function was registered in 4 patients, and the therapy was interrupted in two cases due to renal function impairment. Apart from nephrotoxicity, other CyA side effects were absent.