Clinical efficacy of intravenous immunoglobulin for patients with MPO-ANCA-associated rapidly progressive glomerulonephritis.
BACKGROUND
To determine whether intravenous immunoglobulin (IVIg) can control disease activity in patients with myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA)-associated rapidly progressive glomerulonephritis (RPGN).


METHODS
Twelve patients with serologically and histologically confirmed MPO-ANCA-associated RPGN (7 men, 5 women; mean age 71 +/- 3 years) received IVIg (400 mg/kg/day) alone for 5 days. The effects of IVIg were evaluated by white blood cell counts, serum C-reactive protein levels, Birmingham Vasculitis Activity Score, rate of change in reciprocal creatinine (1/Cre), and plasma tumor necrosis factor-alpha levels after IVIg administration. Corticosteroids with or without cyclophosphamide were commenced after IVIg.


RESULTS
After IVIg treatment, a significant decrease was observed in white blood cell count (p < 0.05), C-reactive protein values (p < 0.001), and Birmingham Vasculitis Activity Score (p < 0.001) concomitant with the amelioration of systemic symptoms. The rate of change in 1/Cre significantly improved (p < 0.05). Plasma tumor necrosis factor-alpha levels that were significantly elevated in patients before IVIg compared with normal controls (p < 0.0001), rapidly declined after IVIg with a significant reduction (p < 0.05). Three months post-treatment with IVIg, all patients showed improvement of disease without serious infectious complications.


CONCLUSIONS
IVIg is a potential component of remission induction therapy for patients with MPO-ANCA-associated RPGN.
Ito-Ihara
Toshiko
T
Department of Nephrology and Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Ono
Takahiko
T
Nogaki
Fumiaki
F
Suyama
Katsuo
K
Tanaka
Mari
M
Yonemoto
Satomi
S
Fukatsu
Atsushi
A
Kita
Toru
T
Suzuki
Kazuo
K
Muso
Eri
E
D000368:Aged; D000369:Aged, 80 and over; D019268:Antibodies, Antineutrophil Cytoplasmic; D002097:C-Reactive Protein / Q000032:analysis; D003401:Creatine / Q000097:blood; D003520:Cyclophosphamide / Q000627:therapeutic use; D016207:Cytokines / Q000097:blood; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D005921:Glomerulonephritis / Q000188:drug therapy*; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000473:pathology; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009195:Peroxidase; D011239:Prednisolone / Q000627:therapeutic use; D012074:Remission Induction; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D019268:Antibodies, Antineutrophil Cytoplasmic; D016207:Cytokines; D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D003520:Cyclophosphamide; D002097:C-Reactive Protein; D011239:Prednisolone; D009195:Peroxidase; D003401:Creatine