Rapidly Progressive Glomerulonephritis Medication
- Author: James W Lohr, MD; Chief Editor: Vecihi Batuman, MD, FACP, FASN more...
Medication Summary
The goals of pharmacotherapy are to induce remission, to reduce morbidity, and to prevent complications.
Antineoplastic agents
Class Summary
Has potent immunosuppressive properties.
Cyclophosphamide (Cytoxan)
Chemically related to nitrogen mustards. Transformed primarily in the liver to active alkylating metabolites. The mechanism of action of the active metabolites may involve cross-linking of DNA, which may interfere with growth of normal and neoplastic cells. PO and IV administration appear to be equally efficacious, although controversy exists.
Corticosteroids
Class Summary
Used for immunosuppressive and anti-inflammatory effects.
Methylprednisolone (Solu-Medrol)
Decreases inflammation by suppressing migration of PMN leukocytes and reversing increased capillary permeability. After 3 d, switch to PO prednisone.
Prednisone (Deltasone, Sterapred, Orasone)
Immunosuppressant for treatment of autoimmune disorders; may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. Stabilizes lysosomal membranes and suppresses lymphocytes and antibody production.
Immunosuppressant agents
Class Summary
May be an effective substitution for cyclophosphamide.
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. Protocol widely and successfully used in Europe is substitution of azathioprine for cyclophosphamide after 3-mo induction period.
Davies DJ, Moran JE, Niall JF, et al. Segmental necrotising glomerulonephritis with antineutrophil antibody: possible arbovirus aetiology?. Br Med J (Clin Res Ed). Aug 28-Sep 4 1982;285(6342):606. [Medline].
Hall JB, Wadham BM, Wood CJ, et al. Vasculitis and glomerulonephritis: a subgroup with an antineutrophil cytoplasmic antibody. Aust N Z J Med. Jun 1984;14(3):277-8. [Medline].
Falk RJ, Hogan S, Carey TS, et al. Clinical course of anti-neutrophil cytoplasmic autoantibody-associated glomerulonephritis and systemic vasculitis. The Glomerular Disease Collaborative Network. Ann Intern Med. Nov 1 1990;113(9):656-63. [Medline].
Nachman PH, Hogan SL, Jennette JC, et al. Treatment response and relapse in antineutrophil cytoplasmic autoantibody-associated microscopic polyangiitis and glomerulonephritis. J Am Soc Nephrol. Jan 1996;7(1):33-9. [Medline].
Villa-Forte A, Clark TM, Gomes M, et al. Substitution of methotrexate for cyclophosphamide in Wegener granulomatosis: a 12-year single-practice experience. Medicine (Baltimore). Sep 2007;86(5):269-77. [Medline].
Berden AE, Jones RB, Erasmus DD, et al. Tubular Lesions Predict Renal Outcome in Antineutrophil Cytoplasmic Antibody-Associated Glomerulonephritis after Rituximab Therapy. J Am Soc Nephrol. Feb 2012;23(2):313-321. [Medline].
Andrassy K, Kuster S, Waldherr R, et al. Rapidly progressive glomerulonephritis: analysis of prevalence and clinical course. Nephron. 1991;59(2):206-12. [Medline].
Bacani RA, Velasquez F, Kanter A, et al. Rapidly progressive (nonstreptococcal) glomerulonephritis. Ann Intern Med. Sep 1968;69(3):463-85. [Medline].
Couser WG. Rapidly progressive glomerulonephritis: classification, pathogenetic mechanisms, and therapy. Am J Kidney Dis. Jun 1988;11(6):449-64. [Medline].
de Lind van Wijngaarden RA, Hauer HA, Wolterbeek R, et al. Chances of renal recovery for dialysis-dependent ANCA-associated glomerulonephritis. J Am Soc Nephrol. Jul 2007;18(7):2189-97. [Medline].
Hogan SL, Nachman PH, Wilkman AS, et al. Prognostic markers in patients with antineutrophil cytoplasmic autoantibody-associated microscopic polyangiitis and glomerulonephritis. J Am Soc Nephrol. Jan 1996;7(1):23-32. [Medline].
Hotta O, Ishida A, Kimura T, et al. Improvements in treatment strategies for patients with antineutrophil cytoplasmic antibody-associated rapidly progressive glomerulonephritis. Ther Apher Dial. Oct 2006;10(5):390-5. [Medline].
Jayne DR, Gaskin G, Pusey CD, et al. ANCA and predicting relapse in systemic vasculitis. QJM. Feb 1995;88(2):127-33. [Medline].
[Best Evidence] Jayne DR, Gaskin G, Rasmussen N, et al. Randomized trial of plasma exchange or high-dosage methylprednisolone as adjunctive therapy for severe renal vasculitis. J Am Soc Nephrol. Jul 2007;18(7):2180-8. [Medline].
Jennette JC. Renal involvement in systemic vasculilits. In: Jennette JC, Olson JL, Schwartz MM, Silva FG, eds. Hepinstall's Pathology of the Kidney. 5th ed. Philadelphia: Lippincott-Raven; 1998:1059-94.
Pusey CD, Rees AJ, Evans DJ, et al. Plasma exchange in focal necrotizing glomerulonephritis without anti-GBM antibodies. Kidney Int. Oct 1991;40(4):757-63. [Medline].
Savige J, Davies D, Falk RJ, et al. Antineutrophil cytoplasmic antibodies and associated diseases: a review of the clinical and laboratory features. Kidney Int. Mar 2000;57(3):846-62. [Medline].
Stilmant MM, Bolton WK, Sturgill BC, et al. Crescentic glomerulonephritis without immune deposits: clinicopathologic features. Kidney Int. Feb 1979;15(2):184-95. [Medline].
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