Aggressive treatment with pulse methylprednisolone or plasma exchange is justified in rapidly progressive glomerulonephritis.

Rapidly progressive crescentic glomerulonephritis (RPGN) carries a poor prognosis, but early immunosuppression may reverse renal impairment. We have given intensive therapy to 27 patients with biopsy proven RPGN from 1977-1981. Fourteen patients received pulse methylprednisolone (PMP) and 13 patients plasma exchange (Px). These patients fared significantly better than 17 patients seen from 1972-1979 who had neither PMP nor Px. Both groups received oral prednisolone and other immunosuppressive agents. PMP and Px were equally effective in prolonging survival without dialysis and had no serious side effects; prognostic factors affecting the outcome of treatment were identified. Early aggressive immunosuppressive therapy is indicated in RPGN.