Lockwood C M, Pinching A J, Sweny P, Rees A J, Pussell B, Uff J, Peters D K
Lancet. 1977 Jan 8;1(8002):63-7. doi: 10.1016/s0140-6736(77)91079-0.
Nine patients with fulminating immune-complex crescentic nephritis were treated by a regimen of intensive plasma-exchange, steroids, and cytotoxic drugs. In five patients with severe renal failure there was early and rapid improvement in renal function; in one patient an early but extensive focal necrotising glomerulitis was arrested; in two patients improvement was delayed for 3 and 7 weeks and could not confidently be attributed to therapy; one patient, anuric at presentation, did not recover renal function. Follow-up renal biopsy specimens, obtained in three patients, showed no evidence of active disease. With the Clq-deviation test, circulating immune complexes were detected in five patients before treatment and had disappeared when renal function had improved and stabilised: these patients showed the best response to therapy. In three patients temporary withdrawal of plasma-exchange was followed by the reappearance of immune complexes in the circulation and was accompanied in two patients by deterioration in renal function; reintroduction of plasma-exchange was followed by elimination of immune complexes and further improvement in renal function.
9例暴发性免疫复合物新月体性肾炎患者接受了强化血浆置换、类固醇和细胞毒性药物治疗方案。5例严重肾衰竭患者的肾功能早期迅速改善；1例患者早期广泛的局灶性坏死性肾小球肾炎得到控制；2例患者的改善延迟了3周和7周，不能确定这是否归因于治疗；1例患者就诊时无尿，未恢复肾功能。3例患者的随访肾活检标本未显示活动性疾病迹象。通过Clq偏差试验，5例患者在治疗前检测到循环免疫复合物，当肾功能改善并稳定时这些复合物消失：这些患者对治疗反应最佳。3例患者暂时停止血浆置换后，循环中免疫复合物再次出现，2例患者肾功能恶化；重新进行血浆置换后，免疫复合物被清除，肾功能进一步改善。
