INFLUENCE OF AGE ON THE PROGNOSIS OF RAPI DLY PROGRESSIVE GLOMERULONEPHRITIS

The evolution and prognosis of extracapillary glomerulonephritis were compared in two cohorts of patients treated between 1981 and 1986 (n = 39) and between 1989 and 1991 (n = 30). In the first group, the class ical immunosuppressive treatment (steroids and cyclophosphamide) was g iven daily and combined with plasma exchanges. In the second group, IV pulses of methylprednisolone and cyclophosphamide were administered, followed hy daily low-dose steroid therapy. Plasma exchanges were perf ormed only in cases of extrarenal disease, particularly pulmonary hemo rrhage. Although the two groups are not strictly similar, it could be concluded that aggressive immunosuppression including plasma exchanges impairs the vital prognosis by inducing infectious and/or hemorrhagic complications, especially in the elderly. On the other hand, methylpr ednisolone and cyclophosphamide pulses appear to have effectively trea ted extracapillary glomerulonephritis and were well tolerated. Thus th ey could be administered to all patients with rapidly progressive glom erulonephritis, including aged patients.