Immunosuppressive therapy in persistent hypocomplementemic glomerulonephritis and in lupus nephritis

In 17 patients, active (diffuse) lupus glomerulonephritis was treated with a combination of mechlorethamine (HN₂) and a high dose of corticosteroids (HDS). Serial clinical and sequential histologic observations were made. The results were compared with those from a previously reported and comparable group of patients who were treated with HDS alone. The mortality rate seen in the more severely affected patients was similar in both groups and there was no significant difference in estimated survival. By contrast, in those in whom the kidneys were less severely affected, the estimated survival appeared to be better in those treated with HDS-HN₂. Control of histologic activity also occurred more rapidly in the HDS-HN₂ group.

Section: Discussionmentioning

confidence: 99%

The Effect of Treatment with Prednisone and Nitrogen Mustard on the Renal Lesions and Life Span of Patients with Lupus Glomerulonephritis

Dillard¹,

Dujovne²,

Pollak³

et al. 1973

“…As antimetabolites have been reported to have a salubrious effect in patients with SLE [2,6,7,9,14,16,40] as well as in a variety of other 'auto immune' diseases [2,6,7,14,16,25,26,36,39] and have proven effective in preventing or minimizing damage in transplanted kidneys [5,13,35], it seemed reasonable to us, as it has to others [16,30,33,40], to use azathioprine in the treatment of a group of patients with active proliferative glomerulo nephritis due to SLE.…”

mentioning

confidence: 99%

Comparison of Azathioprine, Prednisone, and Heparin Alone or Combined in Treating Lupus nephritis

Cade

Spooner

Schlein

et al. 1973

139

50 patients with proliferative glomerulonephritis due to lupus erythematosus were assigned in order of their chronologic appearance at the hospital alternately to treatment with either daily high dose prednisone, azathioprine, prednisone and azathioprine combined, or combined azathioprine and heparin. Prednisone alone was ineffective both from a standpoint of maintaining kidney function or from preserving a state of well being. Only 2 of 15 patients treated with prednisone are doing well with an average survival for the group of 19 months. Azathioprine, alone, appeared very effective with 9 of 13 patients alive and doing well with an average survival of 38 months. Combinations of either azathioprine and prednisone or azathioprine and heparin were most successful, only 2 of 13 in each group died of renal failure. Complications of prednisone administra’ion were high both when prednisone was given alone or in combination with azathioprine.

“…3) also had a rise in /?ic levels to normal with therapy. Associated with the rise was an apparent abatement in severity of the renal disease as described in detail in a previous publication [17]. Proteinuria diminished concurrently with the rise in /9ic levels and serum cholesterol fell from a value of 400 mg% during treatment to 238 mg%.…”

Section: Resultsmentioning

confidence: 61%

“…Indeed, in lupus nephritis, this relationship holds. Therapy with ACTH and adrenal steroids is accompanied by an increase in serum complement [4,13] and /Sic [17] levels and evidence o f healing of the nephritis. The pre sent observations would indicate, however, that in hypocomplemen-temic persistent nephritis the situation is more complex.…”

Section: Discussionmentioning

confidence: 99%

“…At the time o f that report, the levels of /he globulin and the renal biopsy changes were considered equally important in the recognition of the disease. Further, it was assumed that the reduced serum levels of /he globulin, the result, at least in part, of in-vivo breakdown of this pro tein [9,19], were an indicator of continuing immunologic assault on the kidney [3] and that the return o f this protein to normal levels in dicated that progress of the disease had halted [17].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Serum <i>β</i><sub>1C</sub> Globulin Levels in Persistent Glomerulonephritis with Low Serum Complement: Variability Unrelated to Clinical Course

West¹,

McAdams²

1970

Four patients are described with hypocomplementemic persistent glomerulonephritis in whom serum β_1c levels, initially low, rose and remained in the normal range for periods of months to years and then fell to their previous low levels. In two patients, the rise to normal was apparently spontaneous, and in two others it occurred during a course of immunosuppressive therapy. During the time the levels were normal, there were no signs that the nephritis was healing or static. In fact, in one of the patients, renal function deteriorated during the time when the level was normal, and in another, deterioration occurred shortly after the level fell. The observations indicate, first, that the serum β_1C level is not infallible as a diagnostic hallmark of the entity known as hypocomplementemic persistent nephritis and secondly, that there is no clear correlation between the serum β_1C level and the rate of the progression of the nephritis.