de Glas-Vos J W, Krediet R T, Arisz L
Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands.
Neth J Med. 1991 Apr;38(3-4):96-103.
Twenty-five patients with rapidly progressive glomerulonephritis (RPGN) were treated with methylprednisolone (MP) pulse therapy (1 g intravenously on 3 successive days). In all patients renal biopsy was done before or just after the start of therapy. Pulse therapy was used in all patients in combination with a low oral maintenance dose of prednisone. In 21 patients additional immunosuppressive treatment was given, either cyclophosphamide (n = 19) or azathioprine (n = 2); in 2 patients plasmapheresis was also applied. Sixteen of the 25 patients were dialysis-dependent at presentation; 11 of them improved, an additional 3 had a temporary recovery, but needed maintenance renal replacement therapy after 5-46 months, mean 22 months. Nine of the 25 patients were not dialysis-dependent, 6 of them improved, an additional one had a temporary recovery, but needed chronic dialysis after 35 months. When many irreversible glomerular lesions were present, the effectiveness of MP pulse therapy was limited or only of a temporary character. Serious side effects did not occur. In conclusion MP pulse therapy is a successful treatment with minimal adverse reactions in patients with RPGN and active histological lesions.
25例快速进展性肾小球肾炎（RPGN）患者接受了甲泼尼龙（MP）冲击治疗（连续3天静脉注射1g）。所有患者在治疗开始前或刚开始治疗后均进行了肾活检。所有患者均采用冲击治疗并联合小剂量泼尼松口服维持。21例患者接受了额外的免疫抑制治疗，其中19例使用环磷酰胺，2例使用硫唑嘌呤；2例患者还接受了血浆置换。25例患者中有16例在就诊时依赖透析；其中11例病情改善，另外3例有短暂缓解，但在5 - 46个月（平均22个月）后需要维持性肾脏替代治疗。25例患者中有9例不依赖透析，其中6例病情改善，另外1例有短暂缓解，但在35个月后需要长期透析。当存在许多不可逆的肾小球病变时，MP冲击治疗的效果有限或只是暂时的。未出现严重副作用。总之，MP冲击治疗是治疗RPGN且有活动性组织学病变患者的一种成功方法，不良反应最小。
