Abstract
12 nephritic patients with proteinuria above 1 g/day were subjected to anticoagulant therapy in combination with pulse therapy. The patients consisted of 6 mesangial proliferative glomerulonephritis, 2 membranoproliferative glomerulonephritis, 2 anaphylactoid purpura nephritis and 2 focal sclerosing glomerulonephritis. In 4 of 6 mesangial proliferative glomerulonephritics proteinuria subsided and renal clearance was improved by treatment with dipyridamole and/or warfarine plus pulse therapy, These 4 patients have been asymptomatic for more than 1 year and a half despite minor hematuria. In one of the other two cases with mesangial proliferation given cyclophosphamide concurrently a complete remission was achieved, but the rest did not respond to the therapy. This form of therapy was without effect besides transient diminution of proteinuria in one of the two cases with membranopro-liferative glomerulonephritis, however, successful outcome including disappearance of proteinuriaa and elevation of serum complement level was obtained in the other. The following 6 patients were treated with combined heparin and pulse therapy. In one of the two anaphylactoid purpura nephritics, who showed massive proteinuria of 15 g/day, this combination therapy was ineffective; only diminution of proteinuria and relief of edema followed but proteinuria of 2-4 g/day is still continuing. The therapy resulted in complete subsidence of proteinuria leading to remission in the other anaphylactoid purpura nephritic with proteinuria of 2-3 g/day. In 2 patients with focal sclerosis a complete remission or a diminution of proteinuria was induced with concurrent use of cyclophosphamide. Thus we consider that the results with this form of treatment are encouraging and warrant further trial in cases refractory to other medications. Heparin is known to be contraindicated to lipoid nephrosis of minimal change group, accordingly, warfarin or dipyridamole is preferable in the management of mesangial proliferative glomerulonephritis. In the patients with membranoproliferative and anaphylactoid purpura nephritis heparin can be used favorable with pulse therapy.
