title: Effects of methylprednisolone and cyclophosphamide pulse therapy on renal infiltrating cells in patients with crescentic glomerulonephritis.
abstract: OBJECTIVE
  To investigate the effects of pulse methylprednisolone (MP) and monthly intravenous cyclophosphamide (CTX) therapy (MP + CTX) on renal infiltrating cells in patients with rapid progressive glomerular nephritis (RPGN).
  
  
  METHODS
  Twelve patients with RPGN (> 50% crescents) were given MP + CTX therapy and received repeated renal biopsies within 4 to 12 weeks after MP + CTX treatment. Seven were diagnosed as type II RPGN, including one case of IgA nephropathy, 2 cases of idiopathic RPGN and 4 cases of lupus nephritis and five were diagnosed as type III RPGN, including 2 cases of idiopathic RPGN and 3 cases of vasculitis. The changes of infiltrating CD4+, CD8+, CD68+ and proliferating cell nuclear antigen-PCNA+ cell levels were determined by four PAP method in glomeruli and interstitium.
  
  
  RESULTS
  In the patients before MP + CTX therapy, there were higher levels of infiltrating CD4+ and CD8+ cells (306 +/- 118 and 223 +/- 98.4Num/mm2) in renal interstitium, CD68+ cells (17.2 +/- 9.95 Num/G) in glomeruli and (1120 +/- 229 Num/mm2) in interstitium, and PCNA+ cells (7.56 +/- 3.57 Num/G) in glomeruli and (17.6 +/- 6.85 Num/mm2) in interstitium as compared with those in the patients after MP + CTX therapy (CD4+/CD8+ cells were 171 +/- 87.5/121 +/- 38.4 Num/mm2, CD68+ cells were 9.04 +/- 4.33 Num/G and 600 +/- 107 Num/mm2, and PCNA+ cells were 2.04 +/- 1.43 Num/G and 9.40 +/- 4.45 Num/mm2). These changes were associated with improving renal dysfunctions (the levels of serum creatinine and proteinuria decreased gradually from 766 +/- 356 to 284 +/- 192 mumol/L and 2.60 +/- 1.46 to 1.29 +/- 0.85 g/day).
  
  
  CONCLUSIONS
  Our data indicate that the renal infiltrating cells may play an important role in renal injury in patients with RPGN. The effects of MP + CTX therapy on improving renal dysfunctions may partially contribute to its amelioration of infiltrating cells in renal tissues. The degrees of CD4+, CD68+, and PCNA+ cells in the kidney may be useful indicators of MP + CTX therapy for RPGN.
authors.affiliation: Jinling Hospital, School of Medicine, Nanjing University, China.
authors.forename: Z
authors.initials: Z
authors.lastname: Tang
authors.forename: H
authors.initials: H
authors.lastname: Zhou
authors.forename: X
authors.initials: X
authors.lastname: Yao
authors.forename: W
authors.initials: W
authors.lastname: Hu
authors.forename: L
authors.initials: L
authors.lastname: Leishi
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D015703:Antigens, CD / Q000378:metabolism; D015214:Antigens, Differentiation, Myelomonocytic / Q000378:metabolism; D015496:CD4-Positive T-Lymphocytes / Q000187:drug effects*; D018414:CD8-Positive T-Lymphocytes / Q000187:drug effects; D002648:Child; D003520:Cyclophosphamide / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D005921:Glomerulonephritis / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007668:Kidney / Q000473:pathology; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D018809:Proliferating Cell Nuclear Antigen / Q000378:metabolism; D000097382:CD68 Molecule
chemical_list: D000893:Anti-Inflammatory Agents; D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D003520:Cyclophosphamide; D007166:Immunosuppressive Agents; D008775:Methylprednisolone; D018809:Proliferating Cell Nuclear Antigen; C067980:CD68 antigen, human; D000097382:CD68 Molecule