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The treatment of severe glomerulopathies in children using high dose intravenous methylprednisolone pulses
Insights
High-dose methylprednisolone (steroid pulses) improved kidney function in severe proliferative glomerulonephritis and nephrotic syndrome. This treatment may prevent long-term renal damage, with few side effects observed.
Area of Science:
- Nephrology
- Immunosuppressive Therapy
Background:
- Severe proliferative glomerulonephritis and nephrotic syndrome can lead to significant renal function loss.
- Conventional treatments may be insufficient for some patients, necessitating alternative therapeutic strategies.
Purpose of the Study:
- To evaluate the efficacy of high-dose methylprednisolone (steroid pulses) followed by oral prednisone in patients with severe proliferative glomerulonephritis and steroid-resistant/dependent nephrotic syndrome.
- To assess the impact of this treatment on renal function, proteinuria, and urine sediment abnormalities.
Main Methods:
- Thirty-five patients (29 with glomerulonephritis, 6 with nephrotic syndrome) received intravenous methylprednisolone pulses followed by oral prednisone.
- Treatment duration was 6 months or longer.
Main Results:
- Twenty-one of 29 glomerulonephritis patients showed sustained renal function improvement.
- Pulse therapy reduced proteinuria and urine abnormalities in glomerulonephritis patients; non-responders had longer disease duration.
- Five of six nephrotic syndrome patients experienced reduced proteinuria, with three achieving prolonged remission.
- Few side effects were reported with pulse therapy.
Conclusions:
- Steroid pulses may limit or prevent long-term renal function loss in severe proliferative glomerulonephritis.
- This approach may also be effective for steroid-refractory or relapsing nephrotic syndrome.
- The therapeutic strategy warrants further investigation.
Abstract:
Thirty-five patients, 29 with severe proliferative glomerulonephritis and six with either steroid resistant or steroid dependent nephrotic syndrome, were treated with high dose bolus infusions of methylprednisolone (pulses) followed by prednisone given orally in more conventional doses for 6 mo or longer. Twenty-one of the 29 patients with severe proliferative glomerulonephritis had sustained improvement in renal function after treatment. In addition, pulse treatments reduced proteinuria and urine sediment abnormalities in these patients. Those who did not respond had a long duration of disease before receiving pulse therapy. Five of six patients with the nephrotic syndrome had reduction in proteinuria and three of these patients entered prolonged remission after treatment. Few side effects occurred with pulse therapy. Our observations suggest that the use of steroid pulses may limit or prevent long-term major loss of renal function in many patients with severe proliferative glomerulonephritis. It may be effective also in treatment of some patients with steroid refractory or frequently relapsing nephrotic syndrome. This therapeutic approach deserves continuing evaluation.