Response of type I membranoproliferative glomerulonephritis to pulse methylprednisolone and alternate-day prednisone therapy
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1Department of Pediatrics, Indiana University School of Medicine, Indianapolis, USA.
Insights
Corticosteroid therapy, including pulse methylprednisolone, significantly improved kidney function and reduced hematuria in children with type I membranoproliferative glomerulonephritis (MPGN). Long-term follow-up showed persistent benefits, suggesting this treatment aids early disease stabilization.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Immunosuppressive Therapy
Background:
- Type I membranoproliferative glomerulonephritis (MPGN) is a serious kidney disease in children.
- Effective long-term treatment strategies for MPGN remain a focus of research.
Purpose of the Study:
- To evaluate the efficacy and long-term outcomes of corticosteroid therapy in children with biopsy-confirmed type I MPGN.
- To assess the impact of initiating treatment with pulse methylprednisolone on disease stabilization.
Main Methods:
- Sixteen children with type I MPGN received six alternate-day intravenous pulses of methylprednisolone followed by alternate-day prednisone.
- Treatment duration ranged from 12-66 months, with an average follow-up of 52 months.
- Clinical parameters including hematuria, serum albumin, creatinine clearance, and proteinuria were assessed before and after therapy.
Main Results:
- Significant improvements were observed in hematuria, serum albumin, creatinine clearance, and proteinuria after 3 months of therapy (P < 0.05).
- These improvements persisted throughout the follow-up period.
- Repeat kidney biopsies indicated a reduction in acute histological changes, though chronic changes increased.
Conclusions:
- Corticosteroid therapy, particularly initiated with pulse methylprednisolone, is beneficial for children with type I MPGN.
- This treatment approach appears to promote early stabilization of the disease and offers long-term benefits.
- While most patients showed sustained improvement, some continued to exhibit proteinuria despite normal renal function.
Abstract:
Sixteen children with biopsy-confirmed type I membranoproliferative glomerulonephritis (MPGN) were treated with six alternate-day intravenous pulses of methylprednisolone followed by single-dose alternate-day prednisone for 12-66 months (mean 37 months). The average length of follow-up was 52 months (range 12-127 months). Compared with pretreatment values, the frequency of hematuria (13/16 vs. 8/16, P < 0.05) and the levels of serum albumin (2.66 +/- 0.69 vs. 3.76 +/- 0.39 g/dl, P < 0.001), creatinine clearance (97 +/- 37 vs. 129 +/- 26 ml/min/1.73 m2, P < 0.001), and proteinuria (5.2 +/- 5.1 vs. 1.0 +/- 0.8 g/day, P < 0.001) were significantly improved after 3 months of therapy. Improvement has persisted through the end of the follow-up period. Repeat kidney biopsies showed a significant reduction in acute changes but an increase in chronic changes. Thirteen patients have been off therapy from 1 to 74 months (mean 20.8 months). Nine have a normal urinalysis, creatinine clearance, and protein excretion. The remainder have normal renal function but proteinuria ranging from 3.2 to 4.3 g/day. The data support the evidence of other investigators that corticosteroid therapy is beneficial in type I MPGN and suggest that initiation with pulse methylprednisolone may promote early stabilization of the disease.