Effects of methylprednisolone pulse therapy on progressive IgA nephropathy

: In order to estimate the effects of methylprednisolone pulse therapy on progressive IgA nephropathy, clinical parameters in eight patients with the disease were compared between before and after the therapy. In this study progressive IgA nephropathy was defined as follows; 24 hour urinary protein excretion was (++) or more and renal biopsy carried out just before the therapy revealed crescents, inevitably including cellular crescents, in 10% or more glomeruli observed. Methylprednisolone 1000 mg a day was intravenously administered for three consecutive days and the therapy was repeated with an interval of 4 days. The additional third course was given in two patients, in whom significant decrease in urinary protein had not been obtained after the original two courses of the therapy. Oral prednisolone 20 mg a day started simultaneously was tapered one month later to maintenance daily doses of 5-10 mg. After the pulse therapy urinary protein excretion was significantly decreased in every patient with a mean decrease from 2.3 +/- 0.5 (0.8-5.5)g to 1.1 +/- 0.3 (0-2.8)g (p less than 0.05). Glomerular filtration rate (GFR) was increased from 83 +/- 11 (31-115) ml/min to 96 +/- 10 (44-130) ml/min (p less than 0.05). In the initial biopsy crescents were observed in 25 +/- 7 (19-57)% of glomeruli observed and 20-100% of these were composed of cellular crescents. Complete loss of cellular crescents in 6 patients and a marked decrease from 73% to 33% in another were demonstrated by the second biopsies performed after the pulse therapy. These results suggested that the methylprednisolone pulse therapy significantly reduced urinary protein excretion and improved renal function through suppression of new crescent formation as well as transformation of cellular crescents to fibrocellular or fibrous crescents.