Cytostatic Treatment of Glomerular Diseases

Abstract

Forty‐six patients with chronic glomerular diseases have been treated with azathioprine for up to 84 months. The importance of the variables sex, age, clinical diagnosis, histological glomerular changes, arterial hypertension, treatment with prednisone and initial values of serum creatinine and proteinuria was investigated. In 22 patients the renal state as estimated by serum creatinine, proteinuria and urinary sediment was normalized or improved. The renal state was unchanged in 9 patients and deteriorated in 12. The clinical diagnoses glomerulonephritis and idiopathic nephrotic syndrome, normal arterial BP and normal initial serum creatinine concentration were correlated to the improvement. Five of 26 patients deteriorated after withdrawal of azathioprine. Eighteen patients died during the study, 7 from uremia, 2 from side‐effects of the cytostatic treatment and 9 from other diseases. Initial serum creatinine concentration was the only variable correlated to survival.

Cytostatic Treatment of Glomerular Diseases. V

“…Because of the side-effects the indications for cytostatic drugs in renal glomerular disease are limited. In previous studies we have demonstrated a beneficial effect of 16 weeks of treatment with cyclophospharnide on glomerulonephritis as evaluated by Screatinine and proteinuria (1). The improvement occurred primarily within the first 4 weeks.…”

“…Consequently, the null hypothesis as well as the alternative hypothesis has to be defmed. The results from our previous study (1) were used for that purpose. In Table II empiric distributions for improved, unchanged, and deteriorated are listed for cyclophosphamide-treated and for placebo-treated patients from the previous study.…”

“…The three regimes were compared mutually after 6 and 16 weeks as well as to the previously reported controlled trial of 16 weeks of treatment with cyclo-Abbreuiations: C = cyclophosphamide, A = azathioprine, P = prednisone, GFR = glomerular filtration rate. phosphamide (1). A placebo group was not included as the efficacy of cyclophosphamide has been established (1).…”

Prognosis in Glomerulonephritis

“…The histological classification included the following groups: minimal changes, epimembranous, proliferative, exudative, extracapillary, membranoproliferative, lobular, segmental-focal, and unclassified GN. The basis for this classification and the technical procedures have been presented in a previous paper (1). Immunofluorescence and electron microscopy findings were not included in the classification procedure, as these investigations were not systematically performed.…”