Effects of methylprednisolone and cyclophosphamide pulse therapy on renal infiltrating cells in patients with crescentic glomerulonephritis.
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.
Tang
Z
Z
Jinling Hospital, School of Medicine, Nanjing University, China.
Zhou
H
H
Yao
X
X
Hu
W
W
Leishi
L
L
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
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