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Clinical and Experimental Nephrology

, Volume 10, Issue 1, pp 40–54 | Cite as

Deoxyspergualin, an immunosuppressant, in patients suffering from nephropathies with crescent formation: an open-label trial to evaluate safety and efficacy

  • Hirokazu ImaiEmail author
  • Osamu Hotta
  • Mitsuhiro Yoshimura
  • Tsuneo Konta
  • Yoshiharu Tsubakihara
  • Masanobu Miyazaki
  • Chie Tomida
  • Masaki Kobayashi
  • Satoshi Suzuki
  • Hideo Shiiki
  • Atsushi Yamauchi
  • Hitoshi Yokoyama
  • Masato Nose
ORIGINAL ARTICLE

Abstract

Background

Crescent formation in glomeruli means an acute active lesion that develops a rapidly progressive course. Therapies using pulse methylprednisolone, oral corticosteroids, and cyclophosphamide are recommended, but no agreement has been reached on the optimal therapy. There have been no controlled trials, because of the severity of this condition and because withholding treatment would become an ethical issue.

Methods

We evaluated the safety and efficacy of deoxyspergualin (DSG), an immunosuppressant, in a multicenter, prospective trial of 44 patients with crescent formation in over 10% of glomeruli, who were randomly placed into groups that received daily doses of 0.1 mg/kg (n = 21) and 0.2 mg/kg (n = 23) of DSG, given by a 1-h infusion for 4 weeks, and who were then monitored for 3 months. All patients received DSG in this open-label prospective study. We evaluated the levels of urinary protein and hematuria, and examined renal function after the DSG treatment.

Results

Urinary protein significantly decreased with each dose after starting the DSG administration and this efficacy was sustained for 2 months after the discontinuation of DSG. In the groups receiving 0.1 mg/kg and 0.2 mg/kg, mean urinary protein levels were 2.1 g/day and 2.3 g/day at the initiation of the DSG administration, 1.4 g/day and 1.6 g/day at week 4, and 1.5 g/day and 1.3 g/day at week 12, respectively. Hematuria was markedly improved by a dose of 0.2 mg/kg and was not exacerbated following the termination of DSG. Exacerbation of renal dysfunction, as measured by creatinine clearance, serum creatinine, and blood urea nitrogen was prevented by both doses of DSG. The most common adverse reaction was reversible neutropenia.

Conclusions

Short-term treatment with DSG may be effective and tolerated in patients suffering from nephropathies with crescent formation.

Key words

Crescent formation Deoxyspergualin Nephropathies Immunosuppressant Therapy 

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Copyright information

© Japanese Society of Nephrology 2006

Authors and Affiliations

  • Hirokazu Imai
    • 1
    Email author
  • Osamu Hotta
    • 1
  • Mitsuhiro Yoshimura
    • 1
  • Tsuneo Konta
    • 1
  • Yoshiharu Tsubakihara
    • 1
  • Masanobu Miyazaki
    • 1
  • Chie Tomida
    • 1
  • Masaki Kobayashi
    • 1
  • Satoshi Suzuki
    • 1
  • Hideo Shiiki
    • 1
  • Atsushi Yamauchi
    • 1
  • Hitoshi Yokoyama
    • 1
  • Masato Nose
    • 1
  1. 1.Department of Internal Medicine, Division of Nephrology and RheumatologyAichi Medical University School of MedicineAichiJapan

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