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Treatment of Intractable Lupus Nephritis with Total Lymphoid Irradiation

SAMUEL STROBER, M. D.; ELIZABETH FIELD, M.D.; RICHARD T. HOPPE, M.D.; BRIAN L. KOTZIN, M.D.; OVADIA SHEMESH, M.D.; EDGAR ENGLEMAN, M.D.; JON C. ROSS, M.D.; and BRYAN D. MYERS, M.D.
[+] Article and Author Information

Grant support: by grants AM 33340, AM 19985, and AM 20610 from the National Institutes of Health.

▸Requests for reprints should be addressed to Samuel Strober, M.D.; Department of Medicine, Division of Immunology, Stanford University Medical Center; Stanford, CA 94305.


Stanford, California


©1985 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1985;102(4):450-458. doi:10.7326/0003-4819-102-4-450
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Ten patients with lupus nephritis and marked proteinuria (3.9 g or more /d) that did not respond adequately to treatment with prednisone alone or prednisone in combination with azathioprine were treated with total lymphoid irradiation in an uncontrolled feasibility study. Within 6 weeks after the start of total lymphoid irradiation, the serum albumin level rose in all patients in association with a reduction in the serum level of anti-DNA antibodies, an increase in the serum complement level, or both. Improvement in these variables persisted in eight patients followed for more than 1 year, with the stabilization or reduction of the serum creatinine level. Urinary leakage of albumin was substantially reduced in all patients. Side effects associated with radiotherapy included transient constitutional complaints in ten patients, transient blood element depressions in three, localized viral and bacterial infections in four, and ovarian failure in one. The results suggest that total lymphoid irradiation may provide an alternative to cytotoxic drugs in the treatment of lupus nephritis.

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