Abstract
To evaluate the usefulness of steroid pulse therapy fQr treating IgA nephropathy, urinary protein, glomerular filtration rate (GFR), and renal glomerular pathology were compared between before and after two courses of methylprednisolone pulse therapy. It consisted of 1, 000mg of methylprednisolone a day for 3 consecutive days together with oral prednisolone 20mg a day. Twelve patients with progressive IgA nephropathy were included in this study who met the following criteria: i) proteinuria of 1.0g/24 hours or more for at least 3 months and ii) crescent formation in more than 100 of the glomeruli observed.
The daily urinary protein measuredd at 2.5±0.4 (1.0-5.5)g before the purse therapy significantly decreased to 1.5±0.4(0-4.5)g after the therapy (p<0.005). The GFR of 70±10 (31-115) ml/min slightly increased to 78±10 (34-130)ml/min (p<0.05). Renal biopsy carried out before therapy revealed crescents formation in 31±6 (10-57)% of glomeruli observed consisting of cellular crescents in 42±7(10-75)%. After therapy, percentages of glomeruli with crescents did not apparently changed but cellular crescents were not observed in 10 patients and decreased from 73% to 33% in another patient. Urinary protein remained decreased even after 9.5±0.9 (6-16) months in 9 patients but began to increase after 5, 6, and 8 months in 3 patients to the pre-treatment level. These results suggest that the steroid pulse therapy has rapid and reliable effects on progressive IgA nephropathy, and remission for about 6 months can be obtained.
