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Antiglomerular Basement Membrane Disease Medication

  • Author: Ramesh Saxena, MD, PhD; Chief Editor: Vecihi Batuman, MD, FACP, FASN  more...
 
Updated: Dec 04, 2015
 

Medication Summary

The standard treatment of anti-GBM nephritis consists of plasmapheresis in combination with intense immunosuppression. The latter involves high-dose corticosteroids in combination with cyclophosphamide. Rarely, azathioprine or cyclosporine may be used in patients who cannot tolerate cyclophosphamide.

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Corticosteroids

Class Summary

Anti-GBM nephritis is a rapidly progressive disease associated with a high mortality rate if not treated. However, early diagnosis and prompt treatment can prevent progression, preserve renal function, and reduce mortality. High doses of corticosteroids constitute an important component of the intense immunosuppression for anti-GBM nephritis.

Methylprednisolone (Solu-Medrol)

 

Synthetic glucocorticoid for parenteral use. Extremely potent anti-inflammatory activity, ie, greater than that of prednisolone. Has less salt-retaining activity compared with prednisolone. Administered in high doses for the first 3 d in the treatment of anti-GBM nephritis.

Prednisolone (Delta-Cortef, Econopred, AK-Pred)

 

Synthetic glucocorticoid with potent anti-inflammatory properties. Readily absorbed from GI tract. Constitutes important component of immunosuppressive regimen in treatment of anti-GBM nephritis. Administration begins on day 4, after patient has received 3 doses of IV methylprednisolone.

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Immunosuppressives

Class Summary

Cyclophosphamide (an alkylating agent) and corticosteroids constitute the standard immunosuppression regimen for anti-GBM nephritis.

Cyclophosphamide (Cytoxan, Neosar)

 

Synthetic alkylating agent chemically related to nitrogen mustards. Biotransformed in liver to active metabolites. Well absorbed after PO administration (>75% bioavailability). Approximately 5-25% is excreted unchanged in urine. One of its metabolites, acrolein, is thought to be responsible for urinary bladder toxicity.

Azathioprine (Imuran)

 

Antagonizes purine metabolism and inhibits synthesis of DNA, RNA, and proteins. May decrease proliferation of immune cells, which results in lower autoimmune activity.

Cyclosporine (Sandimmune, Neoral)

 

Cyclic polypeptide that suppresses some humoral immunity and, to a greater extent, cell-mediated immune reactions such as delayed hypersensitivity, allograft rejection, experimental allergic encephalomyelitis, and graft versus host disease for a variety of organs.

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Contributor Information and Disclosures
Author

Ramesh Saxena, MD, PhD Professor, Department of Internal Medicine, Division of Nephrology, University of Texas Southwestern Medical Center

Ramesh Saxena, MD, PhD is a member of the following medical societies: International Society for Peritoneal Dialysis, National Kidney Foundation, Texas Medical Association, American Society of Nephrology, International Society of Nephrology

Disclosure: Received honoraria from e-medicine for authoring review articles.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Christie P Thomas, MBBS, FRCP, FASN, FAHA Professor, Department of Internal Medicine, Division of Nephrology, Departments of Pediatrics and Obstetrics and Gynecology, Medical Director, Kidney and Kidney/Pancreas Transplant Program, University of Iowa Hospitals and Clinics

Christie P Thomas, MBBS, FRCP, FASN, FAHA is a member of the following medical societies: American College of Physicians, American Heart Association, American Society of Nephrology, Royal College of Physicians

Disclosure: Nothing to disclose.

Chief Editor

Vecihi Batuman, MD, FACP, FASN Huberwald Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Renal Section, Southeast Louisiana Veterans Health Care System

Vecihi Batuman, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, International Society of Nephrology

Disclosure: Nothing to disclose.

Additional Contributors

Chike Magnus Nzerue, MD, FACP Professor of Medicine, Associate Dean for Clinical Affairs, Meharry Medical College

Chike Magnus Nzerue, MD, FACP is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Society of Nephrology, National Kidney Foundation

Disclosure: Nothing to disclose.

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Light microscopy of kidney biopsy specimen from a patient with antiglomerular basement membrane nephritis showing extensive crescent formation and the collapse of glomerular tuft.
Immunofluorescent examination of a kidney biopsy specimen from a patient with antiglomerular basement membrane nephritis showing a linear deposition of immunoglobulin G along the glomerular basement membrane.
 
 
 
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