Doxycycline decreases proteinuria in glomerulonephritis.
Treatment options for crescentic glomerulonephritis include the use of steroids, cytotoxic therapy, and, in severe cases, intravenous immunoglobulins and plasmapheresis. Injury and lysis of capillary glomerular basement membrane, which is made up of type IV collagen, laminin, fibronectin, and proteoglycans, by serine proteinases and matrix metalloproteinases (MMPs) likely is an important participant in the pathogenesis of crescentic glomerulonephritis. Tetracycline derivatives inhibit not only the activity of MMPs, but also their production, and have been investigated for the treatment of disorders in which the MMP system becomes amplified, such as degenerative osteoarthritis, periodontitis, cancer, and abdominal aortic aneurysm. We report an interesting case of crescentic glomerulonephritis in a young man who was treated with cyclophosphamide and prednisone. The patient developed steroid-induced acne that was treated with long-term oral doxycycline therapy. During the period the patient was administered doxycycline, proteinuria decreased by 70% and recurred when doxycycline was stopped. To our knowledge, this is the first report of possible benefits of a metalloproteinase inhibitor (doxycycline) in glomerulonephritis in humans. Future studies are urgently required to explore the option of metalloproteinase inhibitors in the treatment of proliferative glomerulonephritis.
Ahuja
Tejinder S
TS
Department of Medicine, Division of Nephrology, University of Texas Medical Branch, Galveston, TX, USA. tahuja@utmb.edu
D000152:Acne Vulgaris / Q000139:chemically induced / Q000188:drug therapy; D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001485:Basement Membrane / Q000201:enzymology; D003520:Cyclophosphamide / Q000627:therapeutic use; D004318:Doxycycline / Q000627:therapeutic use*; D015432:Glomerulonephritis, Membranoproliferative / Q000150:complications*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D007678:Kidney Glomerulus / Q000201:enzymology; D008297:Male; D061965:Matrix Metalloproteinase Inhibitors; D008775:Methylprednisolone / Q000009:adverse effects / Q000627:therapeutic use; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D011480:Protease Inhibitors / Q000627:therapeutic use*; D011507:Proteinuria / Q000139:chemically induced* / Q000209:etiology; D013207:Staphylococcal Skin Infections / Q000139:chemically induced / Q000188:drug therapy
D000806:Angiotensin-Converting Enzyme Inhibitors; D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents; D061965:Matrix Metalloproteinase Inhibitors; D011480:Protease Inhibitors; D003520:Cyclophosphamide; D004318:Doxycycline; D011241:Prednisone; D008775:Methylprednisolone