Clinical efficacy of intravenous immunoglobulin for patients with MPO-ANCA-associated rapidly progressive glomerulonephritis.

Abstract

BACKGROUND:

To determine whether intravenous immunoglobulin (IVIg) can control disease activity in patients with myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA)-associated rapidly progressive glomerulonephritis (RPGN).

METHODS:

Twelve patients with serologically and histologically confirmed MPO-ANCA-associated RPGN (7 men, 5 women; mean age 71 +/- 3 years) received IVIg (400 mg/kg/day) alone for 5 days. The effects of IVIg were evaluated by white blood cell counts, serum C-reactive protein levels, Birmingham Vasculitis Activity Score, rate of change in reciprocal creatinine (1/Cre), and plasma tumor necrosis factor-alpha levels after IVIg administration. Corticosteroids with or without cyclophosphamide were commenced after IVIg.

RESULTS:

After IVIg treatment, a significant decrease was observed in white blood cell count (p < 0.05), C-reactive protein values (p < 0.001), and Birmingham Vasculitis Activity Score (p < 0.001) concomitant with the amelioration of systemic symptoms. The rate of change in 1/Cre significantly improved (p < 0.05). Plasma tumor necrosis factor-alpha levels that were significantly elevated in patients before IVIg compared with normal controls (p < 0.0001), rapidly declined after IVIg with a significant reduction (p < 0.05). Three months post-treatment with IVIg, all patients showed improvement of disease without serious infectious complications.

CONCLUSION:

IVIg is a potential component of remission induction therapy for patients with MPO-ANCA-associated RPGN.

• Authors: Toshiko Ito-Ihara, Takahiko Ono, Fumiaki Nogaki, Katsuo Suyama, Mari Tanaka, Satomi Yonemoto, Atsushi Fukatsu, Toru Kita, Kazuo Suzuki, Eri Muso
• Journal: Nephron. Clinical practice (Nephron Clin Pract) Vol. 102 Issue 1 Pg. c35-42 ( 2006) ISSN: 1660-2110 [Electronic] Switzerland
• PMID: 16174989 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: 2006 S. Karger AG, Basel

Chemical References

• Antibodies, Antineutrophil Cytoplasmic
• Cytokines
• Glucocorticoids
• Immunoglobulins, Intravenous
• Immunologic Factors
• Immunosuppressive Agents
• Tumor Necrosis Factor-alpha
• Cyclophosphamide
• C-Reactive Protein
• Prednisolone
• Peroxidase
• Creatine

Topics

• Aged
• Aged, 80 and over
• Antibodies, Antineutrophil Cytoplasmic
• C-Reactive Protein (analysis)
• Creatine (blood)
• Cyclophosphamide (therapeutic use)
• Cytokines (blood)
• Disease Progression
• Drug Therapy, Combination
• Female
• Glomerulonephritis (drug therapy)
• Glucocorticoids (therapeutic use)
• Humans
• Immunoglobulins, Intravenous (therapeutic use)
• Immunologic Factors (therapeutic use)
• Immunosuppressive Agents (therapeutic use)
• Kidney (pathology)
• Leukocyte Count
• Male
• Middle Aged
• Peroxidase
• Prednisolone (therapeutic use)
• Remission Induction
• Tumor Necrosis Factor-alpha (analysis)