title: Treatment of IgA nephropathy with nephrotic syndrome using pulse doses of IgG.
abstract: This paper presents the preliminary results of the treatment of nephrotic syndrome in IgA nephropathy (IgAN) using pulse doses of IgG. Diagnosis was established only by percutaneous ultrasonically-guided renal biopsy, as well as on the basis of typical immunofluorescence and light microscopy findings. Histopathologic changes were classified according to the World Health Organization classification for IgAN, by determination of average glomerular, vascular and interstitial fibrosis indices and the degree of tubular atrophy. IgG therapy was administered in three patients with nephrotic syndrome associated with IgAN characterized by minimal histological changes, i.e., by diffuse mesangioproliferative glomerulonephritis. Initial IgG pulse dose was 0.4 g/kg, given as slow intravenous infusion during three consecutive days in the course of the three-month period. Maintenance therapy consisted of intramuscular IgG in the doses of 2.5 g twice a month, for the next three months. After a six-month treatment, clinical and biochemical remission was achieved in patients with minimal histologic changes, but in other two patients with diffuse mesangioproliferative glomerulonephritis, the effect of the therapy consisted of reduced proteinuria by more than 50%, with the renal function restored to the level before therapy. Transient increase in the serum creatinine level was found in two patients. These preliminary results with IgG pulse therapy, although obtained on a small number of patients, suggest the drug's potent immunomodulatory properties, but its complexity and levels of actions should be further investigated.
authors.affiliation: Military Medical Academy, Clinic of Nephrology, Belgrade.
authors.forename: D
authors.initials: D
authors.lastname: Maksić
authors.forename: M
authors.initials: M
authors.lastname: Marić
authors.forename: J
authors.initials: J
authors.lastname: Dimitrijević
authors.forename: Z
authors.initials: Z
authors.lastname: Kovacević
authors.forename: R
authors.initials: R
authors.lastname: Hrvacević
authors.forename: D
authors.initials: D
authors.lastname: Jovanović
authors.forename: L
authors.initials: L
authors.lastname: Ignjatović
authors.forename: L
authors.initials: L
authors.lastname: Veljancić
mesh_terms: D000328:Adult; D005260:Female; D005922:Glomerulonephritis, IGA / Q000150:complications / Q000628:therapy*; D006801:Humans; D007074:Immunoglobulin G / Q000008:administration & dosage*; D008297:Male; D009404:Nephrotic Syndrome / Q000150:complications / Q000628:therapy*
chemical_list: D007074:Immunoglobulin G