High-dose immunoglobulin therapy for severe IgA nephropathy and Henoch-Schönlein purpura.

Abstract:

OBJECTIVE:To determine if polyvalent IgG is promising therapy for severe IgG nephropathy. DESIGN:Open prospective cohort study. SETTING:Referral nephrology unit. PATIENTS:11 adult patients with severe IgA nephropathy (9 who had idiopathic disease and 2 who had Henoch-Schönlein purpura) and indicators of poor prognosis. INTERVENTION:Patients were given high-dose immunoglobulins (2 g/kg each month) for 3 successive months, followed by intramuscular immunoglobulins (preparation content, 16.5%; 0.35 mL/kg every 15 days) for another 6 months. MEASUREMENTS:Histologic changes were analyzed by comparing pre- and post-therapy renal biopsy specimens blindly, using an activity index (14-point scale), a sclerosis index (10-point scale), and a semiquantitative immunofluorescence test of immune deposits. Proteinuria, hematuria, leukocyturia, enzymuria, and global renal function (creatinine and polyfructosan clearances) were evaluated before and after intervention. RESULTS:Proteinuria (median level before intervention, 5.20 g/d; median level after intervention, 2.25 g/d), hematuria, and leukocyturia decreased substantially. The decrease in glomerular filtration rate was greatly slowed or stopped (median rate of decline in glomerular filtration before, -3.78 mL/min per month; after, 0 mL/min per month). The histologic index of activity (median index before, 5; after, 2) and the staining intensity of glomerular IgA and C3 deposits also decreased. Immunoglobulin therapy was well tolerated. CONCLUSIONS:Immunoglobulin therapy may be effective in treating severe IgA nephropathy and protecting renal function. However, prospective controlled trials must confirm these preliminary results.

journal_name

Ann Intern Med

authors

Rostoker G,Desvaux-Belghiti D,Pilatte Y,Petit-Phar M,Philippon C,Deforges L,Terzidis H,Intrator L,André C,Adnot S,Bonin P,Bierling P,Remy P,Lagrue G,Lang P,Weil B

doi

10.7326/0003-4819-120-6-199403150-00005

subject

Has Abstract

pub_date

1994-03-15 00:00:00

pages

476-84

issue

6

eissn

0003-4819

issn

1539-3704

journal_volume

120

pub_type

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