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[The treatment of chronic glomerulonephritis with ultrahigh doses of cyclophosphane]
Insights
Pulse therapy with cyclophosphamide effectively treated chronic glomerulonephritis in 59% of patients, including those resistant to other immunosuppressors. Treatment success correlated with nephritis activity, not sclerotic changes.
Area of Science:
- Nephrology
- Immunosuppressive Therapy
Context:
- Chronic glomerulonephritis (CGN) with nephrotic syndrome presents diverse morphological patterns.
- Treatment resistance to oral immunosuppressors is a challenge in managing CGN.
Purpose:
- To evaluate the efficacy of pulse cyclophosphamide therapy in patients with various forms of nephrotic CGN.
- To identify predictors of treatment response in this patient cohort.
Summary:
- Pulse cyclophosphamide therapy was administered to 44 CGN patients. Overall efficacy was 59%, with 11 of 24 previously resistant patients achieving remission.
- Positive outcomes were associated with normal serum creatinine and blood pressure. Remission occurred in mesangioproliferative, mesangiocapillary, mesangial glomerulonephritis, and focal-segmental hyalinosis, but not fibroplastic nephritis.
- The activity index, reflecting nephritis activity, was the sole significant predictor of treatment success, while sclerotic changes did not impact outcomes.
Impact:
- Pulse cyclophosphamide offers a viable treatment option for nephrotic CGN, particularly for patients refractory to oral immunosuppressors.
- The activity index serves as a crucial prognostic marker for guiding treatment decisions in CGN management.
Abstract:
Pulse therapy with cyclophosphamide was administered to 44 patients with chronic glomerulonephritis of the nephrotic type with different morphological varieties. The treatment was effective in 59% of cases including 11 out of 24 patients resistant to oral treatment with immunosuppressors. The treatment results were better in patients with normal blood serum creatinine and normal arterial pressure. Remission of the nephrotic syndrome could be observed in mesangioproliferative glomerulonephritis, mesangiocapillary glomerulonephritis, mesangial glomerulonephritis and focal-segmentary hyalinosis. In fibroplastic nephritis, remission of the nephrotic syndrome was recorded in none of the cases. The only prognostically significant sign predicting the treatment effect was the activity index--the totality of the morphological signs reflecting nephritis activity. The sclerotic changes produced no significant effect on the treatment outcome.