Summary
Of 30 therapy studies which distinguish between improved and non-improved renal function, 350 patients with rapidly progressive glomerulonephritis (RPGN) were evaluated. Pure descriptions of cases were not included. The cases of RPGN were divided into autoantibody-induced and non-autoantibody-induced groups. This latter group was subdivided into idiopathic and symptomatic RPGN. A further distinction was drawn between the different forms of symptomatic RPGN, but no separate evaluations were made, on account of the small numbers of cases. Therapies were divided into immunosuppression, anticoagulant therapy, pulse therapy, and therapeutic plasmapheresis. In autoantibody-induced RPGN, improved renal function was evidenced in only five cases out of 27. In contrast to this, 66% of the non-oliguric patients with creatinine levels >6 mg/dl showed improved renal function after plasma separation. In non-autoantibody-induced RPGN, the least favourable results were shown by anticoagulant treatment, where improvement in renal function was produced in only 34% of the cases treated, and haemorrhagic complications occurred in 25%, about half of which had a fatal outcome. Under pulse therapy, 27 out of 38 patients (71%) showed improvement, as against 59 out of 93 (63%) under plasmapheresis. In contrast to the situation in autoantibody-induced RPGN, it is possible in non-autoantibody-induced RPGN to achieve therapy-induced improvement also in a high percentage of cases where terminal renal insufficiency is present, and even when dialysis treatment has just been commenced. The collected statistics for therapeutic results achieved in RPGN are compared and contrasted with two controlled studies which showed diverging findings.
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References
Arieff AI, Pingerra WF (1972) Rapidly progressive glomerulonephritis treated with anticoagulants. Arch Intern Med 129:77–84
Asaba H, Rekola S, Bergstrand A, Wassermann H, Bergström J (1980) Clinical trial of plasma exchange with a membrane filter in treatment of crescentic glomerulonephritis. Clin Nephrol 14:60–65
Beirne GJ, Wagnild JP, Zimmerman SW, Macken PD, Burkholder PM (1979) Idiopathic crescentic glomerulonephritis. Medicine 56:349–381
Beyer J, Hayduk K, Riegger G, Steilner H, Liebau G (1981) Kombinierte Antikoagulantien- und Immunsuppressivtherapie bei rapid progressiver Glomerulonephritis. Therapiewoche 31:650–652
Blumenstein M, Samtleben W, Habersetzer R, Gurland HJ (1982) Plasma-Austausch bei Nierenerkrankungen. Dtsch Med Wochenschr 107:1854–1856
Bolton WK, Couser WG (1979) Intravenous pulse methylprednisolone therapy of acute crescentic rapidly progressive glomerulonephritis. Am J Med 66:495–502
Bolton WK (1982) Pulse methylprednisolone therapy of polyarteritis nodosa (PAN) acute crescentic rapidly progressive glomerulonephritis (AC-RPGN). Kidney Int 21:145
Brown CB, Turner D, Ogg CS, Wilson D, Cameron JS, Chantler C, Gill D (1974) Combined immunosuppression and anticoagulation in rapidly progessive glomerulonephritis. Lancet II:1166–1172
Bruns FJ, Fraley DS, Adler S, Segel DP (1981) Megadose methylprednisolone versus plasmapheresis in treatment of rapidly progressive glomerulonephritis (RPGN). Kidney Int 19:121
Cameron JS, Gill D, Turner DR, Chantler C, Ogg CS, Vosnides G, Williams DG (1975) Combined immunosuppression and anticoagulation in rapidly progressive glomerulonephritis. Lancet II:923–925
Cameron JS (1979) The natural history of glomerulonephritis. In: Kincaid-Smith P, d'Apice AJF, Atkins RC (eds) Progress in glomerulonephritis. Wiley & Sons, New York, pp 1–25
Dosa S, Mallick NP, Lawler W, Cairns SA, Slotki IN (1978) The treatment of lupus nephritis by methyl prednisolone pulse therapy. Postgrad Med J 54:628–632
Glöckner WM, Dienst C, Kindler J, Sieberth HG (1981) Plasmaaustausch zur Behandlung der rapid progressiven Glomerulonephritis. Dtsch Med Wochenschr 106:1616–1620
Hind CRK, Lockwood CM, Peters DK, Paraskevakou H, Evans DJ, Rees AJ (1983) Prognosis after immunosuppression of patients with crescentic nephritis requiring dialysis. Lancet I:263–265
Jensen H, Ølgaard K, Faarup P (1974) Successful immunosuppressive treatment of oliguric extracapillary glomerulonephritis. Acta Med Scand 196:383–386
Johnson JP, Whitman W, Briggs WA, Wilson CB (1978) Plasmapheresis and immunosuppressive agents in antibasement membrane antibody-induced Goodpasture's Syndrome. Am J Med 64:354–359
Kauffmann RH, Houwert DA (1981) Plasmapheresis in rapidly progressive Henoch-Schoenlein gomerulonephritis and the effect on circulating IgA immune complexes. Clin Nephrol 16:155–160
Lerner RA, Glassock RJ, Dixon FJ (1967) The role of antiglomerular basement membrane antibody in the pathogenesis of human glomerulonephritis. J Exp Med 126:989–1004
Lockwood CM, Pearson TA, Rees AJ, Evans DJ, Peters DK, Wilson CB (1976) Immunosuppression and plasma-exchange in the treatment of Goodpasture's Syndrome. Lancet 1:711–715
Lockwood CM, Pinching AJ, Sweny P, Rees AJ, Pussell B, Uff J, Peters DK (1977) Plasma-exchange and immunosuppression in the treatment of fulminating immune-complex crescentic nephritis. Lancet I:63–67
McKenzie PE, Taylor AE, Woodroffe AJ, Seymour AE, Chan YL, Clarkson AR (1979) Plasmapheresis in glomerulonephritis. Clin Nephrol 12:97–108
Morrin PAF, Hinglais, Nabarra B, Kreis H (1978) Rapidly progressive glomerulonephritis — A clinical and pathologic study. Ann J Med 65:446–460
O'Neill WM Jr, Etheridge WB, Bloomer HA (1979) High-dose corticosteroids — Their use in treating idiopathic rapidly progressive glomerulonephritis. Arch Intern Med 139:514–518
Oredugba O, Mazumdar DC, Meyer JS, Lubowitz H (1980) Pulse methylprednisolone therapy in idiopathic, rapidly progressive glomerulonephritis. Ann Intern Med 92:504–506
Pinggera WF, Djawan S, Singer F, Stummvoll HK, Wolf A (1973) Heparintherapie bei perakuter Glomerulonephritis. Wien Z Inn Med 54:417–421
Pusey CD, Lockwood CM (1982) Plasma exchange and immunosuppresive drugs in the management of severe glomerulonephritis. Prog Clin Biol Res 106:91–104
Rifle G, Chalopin JM, Zech P, Deteix P, Ducret F, Vialtel P, Cordonnier D (1980) Treatment of idiopathic acute crescentic glomerulonephritis by immunodepression and plasma-exchanges. A prospective randomised study. Proc Eur Dial Transplant Assoc 18:493–502
Saxon A, Stevens RH, Ramer SJ, Clements PJ, Yu DTY (1978) Glucocorticoids administered in vivo inhibit human suppressor T lymphocyte function and diminish B lymphocyte responsiveness in in vitro immunoglobulin synthesis. J Clin Invest 61:922–930
Sieberth HG, Glöckner WM (1983) Plasmapheresetherapie bei Nierenerkrankungen. Internist 24:27–33
Suc JM, Durand D, Conte J, Mignon-Conte M, Orfila C, Ton That H, Duchet JP (1976) The use of heparin in the treatment of idiopathic rapidly progressive glomerulonephritis. Clin Nephrol 5:9–13
Schreiner GE, Rakowski TA, Argy WD Jr, Marc-Aurele J, Maher FJ, Bauer H (1973) Natural history of oliguric glomerulonephritis. In: Kincaid-Smith P, Mathew TH, Becker EI (eds) Glomerulonephritis. Morphology, natural histology, and treatment, part II. Wiley & Sons, New York, p 711
Schulz W, Gessler U (1977) Diagnostik, Therapie und Verlauf der rasch progressiven glomerulären Insuffizienz. Therapiewoche 27:7441–7462
Stilmant MM, Bolton WK, Sturgill BC, Schmitt GW, Couser WG (1979) Crescentic glomerulonephritis without immune deposits: Clinicopathologic features. Kidney Int 15:184–195
Thysell H, Bygren P, Bengtsson U, Lindholm T, Norlin M, Jonsson M, Brun C, Larsen S, Jorgensen F, Sjöholm A, Laurell AB (1982) Immunosuppression and the additive effect of plasma exchange in treatment of rapidly progressive glomerulonephritis. Acta Med Scand 212:107–114
Wilson CB, Dixon FJ (1973) Antiglomerular basement membrane antibody-induced glomerulonephritis. Kidney Int 3:74–89
van der Woude FJ, Hoorntje SJ, Weening JJ, van Overbeck JJM, van der Hem GK (1982) Renal involvement in Wegener's granulomatosis. Nephron 32:185–187
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An erratum to this article is available at http://dx.doi.org/10.1007/BF01540474.
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Sieberth, H.G., Maurin, N. The therapy of rapidly progressive glomerulonephritis. Klin Wochenschr 61, 1001–1010 (1983). https://doi.org/10.1007/BF01537498
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DOI: https://doi.org/10.1007/BF01537498