METHYLPREDNISOLONE AND CYCLOPHOSPHAMIDE PULSE THERAPY IN CRESCENTIC GLOMERULONEPHRITIS - SAFETY AND EFFECTIVENESS

In a previous study, we found that aggressive immunosuppressive therap y with continuous high-dose oral steroid and cyclophosphamide combined with plasma exchanges for extracapillary crescentic glomerulonephriti s gave controversial results since, although disease activity was cont rolled, iatrogenic complications had led to death in some aged patient s. We then modified our therapeutic regimen, and we analyze here the e volution of 30 consecutive patients who were admitted for biopsy-prove n crescentic glomerulonephritis between 1989 and 1991. The mean plasma creatinine level at admission was 393 +/- 59 mumol/L (range 70 to 110 0), and 15 patients had crescent formation in more than 50% of glomeru li on initial renal biopsy. Ten patients did not receive any immunosup pressive treatment since they either had a normal renal function or th ey had terminal renal failure and no severe extrarenal manifestation. The 20 other patients received initial steroid pulses 500 mg x3 (n = 1 7), low oral steroid treatment (n = 20), cyclophosphamide pulses (n = 13), or oral cyclophosphamide (n = 3). In 4 cases plasma exchanges wer e also used. As a whole, 10 patients (33%) were discharged with a norm al renal function, and 18 patients (60%) had chronic renal failure, 7 of them requiring dialysis or transplantation; only 2 patients died of pulmonary hemorrhage. No severe iatrogenic complication was observed. These results indicate that reduction in oral steroid dosage, cycloph osphamide pulse therapy rather than continuous oral treatment, and pla sma exchanges do not induce overimmunosuppression and iatrogenic compl ication. It can be safe, well tolerated, and as effective as a more in tensive immunosuppressive regimen for the treatment of crescentic extr acapillary glomerulonephritis.