Effects of the Methylprednisolone Pulse Therapy on Renal Function

Abstract

The effect of the methylprednisolone (MP) pulse therapy on renal function was examined in 15 patients with renal or collagen disease. Three nephrotic patients who had reduced renal function and active renal disease with progressive deterioration of renal function prior to the use of MP developed transient renal failure following an MP pulse therapy. The renal failure in each case was reversed by discontinuation of MP and/or by forced diuresis using albumin and furosemide. We examined the correlations between the individual changes in serum creatinine (S_cr), body weight (BW) and urine volume (UV) before and after the pulse therapy and other laboratory data such as S_cr, total serum protein and albumin. There were significant correlations between a change in S_cr on the one hand and changes in BW and UV, S_cr and serum albumin on the other. These findings mean that the effect of the MP pulse therapy on renal function depends on the clinical state of the patient and that renal deterioration after the pulse therapy may be more marked in patients who are more nephrotic and more impaired in renal function and suggest that increasing sodium and water retention during an MP therapy and the associated renal interstitial edema, proposed as one of the mechanisms of acute renal failure occurring in patients with minimal-change nephrotic syndrome, may be responsible for the MP-induced transient renal failure.

Difference between Renal Failure Associated with Methylprednisolone Pulse Therapy and Deterioration of Renal Function Unrelated to Methylprednisolone Therapy

“…When the two groups were compared regarding the increment in SCr levels after pulse therapy, no significant difference was observed. In cases 5 and 6 in group 1. worsening of renal function with respect to S-Cr levels was acutely reversed following diuresis induced by Alb (12.5-25 g/day) and furosemide (up to 200 mg/day), a method that was described in detail in our previous report [9], In the remaining 5 patients, S-Cr spontaneously returned almost to baseline levels by day 13, as shown in table 2 and fig ure 1. In group 2, 5 of the 6 patients eventually underwent dialysis treatment; 3 patients (cases 3.…”

“…We previously reported that post-therapy renal function deteriorated more mark edly in nephrotic patients and that increased sodium and water retention caused by a mineralocorticoid's effect on the renal tubules to increase sodium reabsorption might be responsible for MP-associated renal failure [9,10].…”

“…Renal biopsies were performed in 12 of the 13 patients approxi mately 1 week before pulse therapy; their renal pathologies are shown in table 1. Somewhat arbitrarily, we classified 7 patients as having MP-associated renal deterioration (group 1: serum creatinine levels returned naturally or following induced diuresis to baseline values as previously described) [9,10] and 6 patients as having natural deterio ration of renal function unrelated to MP therapy (group 2; renal function progressively deteriorated and 5 of the 6 patients underwent dialysis).…”

Follow-up on pediatric patients with bronchiolitis obliterans treated with corticosteroid pulse therapy

“…In patients with normal kidney function, the renal effects of pulse therapy seem to be minimal. However, in nephritic patients they can lead to renal deterioration [ 36 ].…”

Plasma exchange combined with immunosuppressive treatment in a child with rapidly progressive IgA nephropathy

“…However, there are no randomized controlled trials of these treatments in crescentic IgA nephropathy, and response to treatment is not uniform. Furthermore, in pervious studies, renal function deterioration associated with methylprednisolone pulse therapy was reported [4], and Kobayashi et al actually described a patient with severe crescentic IgA nephropathy who had a rapid increase in blood urea nitrogen and serum creatinine levels after starting intravenous administration of high-dose methylprednisolone [5]. Although their patient's renal function recovered with combined therapy with prednisolone, dipyridamole, and warfarin, the second renal biopsy still showed a high frequency of glomerular crescent formation and some sclerotic glomeruli.…”