High-dose corticosteroids: their use in treating idiopathic rapidly progressive glomerulonephritis

To evaluate the response of patients with idiopathic rapidly progressive glomerulonephritis (RPGN) to high-dose corticosteroids, we have studied ten consecutive patients with this disorder. All were given 1 g of methylprednisolone intravenously each day for one week and then placed on a high-dose orally administered prednisone regimen. Four of the ten patients with idiopathic RPGN responded with a sustained reduction in the serum creatinine level of at least 50%. The patients who responded were characterized by a symptomatic illness of short duration and normal blood pressure. Renal biopsies in the responding patients showed minimal glomerular and crescentic sclerosis with mild interstitial fibrosis. The nonresponders had a long symptomatic illness with elevated initial blood pressures. The renal tissue in this group had considerable fibrosis of the crescents, glomeruli, and interstitium. The results suggest that a certain group of patients with idiopathic RPGN will improve with high-dose corticosteroid therapy.