Steroid pulse therapy in rapidly progressive glomerulonephritis.
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概要
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In an attempt to clarify the indication and efficacy of the methylprednisolone pulse therapy (1000mg x 3times) for rapidly progressive glomerulonephritis (RPGN), 3 patients with the disease were carefully followed and the clinical course during and after the treatment were precisely analysed. According to the declination rate of reciprocals of serum creatinine(1/Cr), one patient were divided into the acute type (-1.00x10-2dl/mg/day or less) and the others into the subacute type (more than 1.00 × 10-2 dl/mg/day). In the patient of acute type, renal biopsy revealed cellular crescent formation in 93.8% of glomeruli observed. One course of the pulse therapy resulted in a decrease in Cr from 3.0mg/dl to 1.3mg/ dl and transformation of cellular crescents to fibrocellular or fibrous crescents. In the other two patients of subacute type, crescents were observed in 72.7% and 72.0% of glomeruli observed, and 87.5% and 38.9% of them were composed of cellular crescents respectively. lnitial courses of the pulse therapy resulted in decreases of Cr from 3.5mg/dl to 2.4mg/dl and from 3.0mg/dl to 1.4mg/dl respectively. Additional courses, given because of insufficient reduction of Cr in the former, induced a further lowering to 1.3mg/dl, and because of re-elevation of Cr to 2.2mg/dl and remaining of cellular crescents in 20% in the latter, induced a decrease of Cr to 1.5mg/dl and disappearance of cellular crescents. These results suggest that the methyl prednisolone pulse therapy has apparent and prompt effects on RPGN administered when the disease is in an active phase indicated by linear declination of 1/Cr and presence of cellular crescents in glomeruli, and the additional course administered when the disease activity persists indicated by re-elevation of Cr in addition to remaining of cellular crescents, but no more course may be necessary when Cr has been stable.
- 社団法人 日本腎臓学会の論文
社団法人 日本腎臓学会 | 論文
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