High-dose intravenous gammaglobulin for membranous nephropathy (MN), membranoproliferative glomerulonephritis (MPGN) and lupus nephritis (LN)

Abstract

Three cases of idiopathic MN, 2 of MPGN and 3 of LN were demonstrated IgG de-posits along glomerular capillary walls in granular pattern and were dissociated after incubation with human γ-globulin. Furthermore, the dissociation of IgG in glomeruli was observed following incubation with plasmin-treated, PEG-treated, sulfonated kuman γ-globulin and Fc fragment, but not with pepsin-treated human γ-globulin, indicating that Fc fragment may play an important role for the dissociation. These results suggest that immune complexes in the glomeruli consist of the patient's own denatured IgG and IgG-RF. On the basis of these findings, all of the patients were treated with large intravenous dose of plasmin-treated γ-globulin (5g/day, 610 times). In all patients the urine protein and/or hematuria rematuria remarkedly decreased or disappeared within 7 days to 40 days. During 60 to 90 days of observation all patients with these renal diseases could be main-tained in improved status from nephrotic syndrome. No untoward effects of γ-globulin therapy were observed. Thus, administration of high-dose intravenous γ-globulin is useful treatment for MN, LN and MPGN.