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Corticosteroid Therapy in Idiopathic Glomerulonephritis

  • G. Piccoli
  • R. Coppo
  • P. Stratta
  • M. Messina
  • D. Roccatello
  • G. M. Bosticardo
  • F. Quarello
  • S. Alloatti
Part of the Ettore Majorana International Science Series book series (EMISS, volume 9)

Abstract

Corticosteroids have multiple effects on the movement and functional capabilities of inflammatory or immunologically reactive cells, on various soluble factors, on vascular and tissue responses. There is a different sensitivity of various populations and sub-populations of cells to the corticosteroid modulation. These mechanisms are still under discussion, but the final effects appear to support the use of corticosteroids in certain patients with idiopathic glomerulonephritis (GN).

In minimal change GN the 10 years survival after onset was not significantly increased by introducing corticosteroids, but the prompt disappearance of proteinuria (80 per cent of adults by 8 weeks in our own series) supported their use. The problem of corticosteroid treatment in focal sclerosing GN is complicated by the probable coexistence of two histologically indistinguishable forms (one being non-steroid sensitive). In our own series the corticosteroid response, although transient, was present in 7 out of 16 patients. We obtained a high number of total remissions (57 per cent) and partial remissions (14 per cent), in membranous GN, where the conflicting data of the literature suggest differences in the criteria of selection and admission of patients to corticosteroid treatment, calling attention to further controlled trials. In rapidly progressive GN the combined use of corticosteroids, immunosuppressants and heparin has elicited a stabilization or improvement of renal function in 40 per cent of the treated patients. By the same treatment we observed a total remission in 19 per cent and a partial remission in 62 per cent of severely nephrotic patients with the histological appearances of membranoproliferative GN characterized by massive subendothelial deposits of the early complement fractions (C1, C4). Although it is impossible to draw firm conclusions either on pathogenesis of idiopathic GN or on the biochemical, cellular and tissue effects of corticosteroid, these drugs sometimes appear effective in clinical practice.

Keywords

Nephrotic Syndrome Corticosteroid Therapy Partial Remission Membranous Nephropathy Idiopathic Nephrotic Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Plenum Press, New York 1981

Authors and Affiliations

  • G. Piccoli
    • 1
    • 2
  • R. Coppo
    • 1
    • 2
  • P. Stratta
    • 1
    • 2
  • M. Messina
    • 1
    • 2
  • D. Roccatello
    • 1
    • 2
  • G. M. Bosticardo
    • 1
    • 2
  • F. Quarello
    • 1
    • 2
  • S. Alloatti
    • 1
    • 2
  1. 1.Nephrology and Dialysis UnitsS. Giovanni HospitalTurinItaly
  2. 2.Chair of Medical NephrologyUniversity of TurinTurinItaly

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