Palla R, Cirami C, Panichi V, Bianchi A M, Parrini M, Grazi G
2nd Medical Clinic Institute, University of Pisa, Italy.
Clin Nephrol. 1991 Mar;35(3):98-104.
Preliminary results of the efficacy of high-dose intravenous human IgG in patients with biopsy-confirmed idiopathic membranous nephropathy (IMGN) were reported. Five patients with normal renal function (creatinine clearance 125.2 +/- 16 ml/min/1.73 m2 BSA) (Group A) and 4 patients with moderate renal insufficiency (creatinine clearance 65.5 +/- 8.3 ml/min/1.73 m2 BSA) (Group B) received pulse doses of IgG (0.4 g/kg BW) for 3 consecutive days; these 3-day boli were repeated 3 times at 21-day intervals; since then for a 10-month period one bolus once every 3 weeks has been administered. Five responder patients at the end of the trial received a new renal biopsy. In 4 Group A patients complete remission of proteinuria (daily proteinuria less than 0.2 g) was observed, whereas 1 patient showed partial remission (proteinuria 2 g/day). In Group B patients, 1 showed complete remission and 2 partial remission; in 1 patient no variation of proteinuria was noted. In responder patients clinical and biological findings of the nephrotic syndrome disappeared and a statistically significant increase of creatinine clearance was observed. In control biopsies at the end of the trial the immunofluorescence staining failed to find immunodeposits and recovery of glomerular lesions at light microscopy. In conclusion, IgG therapy seems to be of benefit to patients with IMGN but a randomized clinical trial to confirm this preliminary report is needed.
有报道称，对经活检确诊为特发性膜性肾病（IMGN）的患者使用大剂量静脉注射人免疫球蛋白（IgG）的疗效初步结果。5例肾功能正常（肌酐清除率125.2±16 ml/min/1.73 m2体表面积）的患者（A组）和4例中度肾功能不全（肌酐清除率65.5±8.3 ml/min/1.73 m2体表面积）的患者（B组）连续3天接受脉冲剂量的IgG（0.4 g/kg体重）；这3天的大剂量注射每21天重复3次；此后在10个月的时间里，每3周给予一次大剂量注射。试验结束时，5例有反应的患者接受了新的肾活检。A组4例患者蛋白尿完全缓解（每日蛋白尿小于0.2 g），而1例患者显示部分缓解（蛋白尿2 g/天）。B组患者中，1例完全缓解，2例部分缓解；1例患者蛋白尿无变化。有反应的患者肾病综合征的临床和生物学表现消失，肌酐清除率有统计学意义的增加。在试验结束时的对照活检中，免疫荧光染色未发现免疫沉积物，光镜下肾小球病变恢复。总之，IgG治疗似乎对IMGN患者有益，但需要进行随机临床试验来证实这一初步报告。
