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Prognosis after immunosuppression of patients with crescentic nephritis requiring dialysis
Insights
Intensive treatment for rapidly progressive glomerulonephritis (RPGN) improved outcomes for patients without anti-glomerular basement membrane antibodies. Patients with these antibodies did not recover renal function.
Area of Science:
- Nephrology
- Immunology
Background:
- Rapidly progressive glomerulonephritis (RPGN) is a severe kidney disease.
- RPGN often leads to kidney failure, necessitating dialysis.
Purpose of the Study:
- To evaluate the efficacy of intensive immunosuppressive therapy in patients with RPGN.
- To determine factors influencing renal function recovery in RPGN patients.
Main Methods:
- 48 patients with RPGN received intensive plasma exchange, steroids, and cytotoxic drugs.
- Patients requiring dialysis and exhibiting significant crescent formation were included.
- Subgroup analysis based on the presence or absence of anti-glomerular basement membrane antibodies was performed.
Main Results:
- No renal function recovery was observed in 21 patients with anti-glomerular basement membrane antibody disease.
- 63% of patients without these autoantibodies recovered renal function.
- Stable plasma creatinine levels were noted in most long-term survivors, irrespective of initial crescent formation extent in antibody-negative patients.
Conclusions:
- Intensive immunosuppressive therapy shows potential for renal function recovery in RPGN patients lacking anti-glomerular basement membrane antibodies.
- The presence of anti-glomerular basement membrane antibodies is a significant negative prognostic factor for renal recovery in RPGN.
- Crescent formation extent did not correlate with recovery in antibody-negative RPGN patients, suggesting other factors are involved.
Abstract:
48 patients with rapidly progressive glomerulonephritis were treated by a regimen of intensive plasma exchange, steroids, and cytotoxic drugs. All required dialysis before immunosuppressive treatment was started, and all had 50% or more of their glomeruli affected by crescent formation. Renal function was not recovered in any of the 21 patients with anti-glomerular basement membrane antibody disease. In contrast 63% of patients without these autoantibodies recovered renal function. Plasma creatinine remained stable over prolonged follow-up (6-60 months) in all but 1 of the 10 late survivors. There was no correlation between the extent of crescent formation and recovery of renal function in those patients without circulating anti-glomerular basement membrane antibodies.