Use of methotrexate and glucocorticoids in the treatment of Wegener's granulomatosis. Long-term renal outcome in patients with glomerulonephritis

Arthritis Rheum. 2000 Aug;43(8):1836-40. doi: 10.1002/1529-0131(200008)43:8<1836::AID-ANR20>3.0.CO;2-R.


Objective: To determine the long-term renal outcome in patients with Wegener's granulomatosis (WG) and active glomerulonephritis who were treated with methotrexate (MTX) and glucocorticoids.

Methods: An open-label, prospective standardized trial using weekly low-dose MTX and glucocorticoids for the treatment of WG was performed. Forty-two patients were enrolled into the study, of whom 21 had active glomerulonephritis as a disease manifestation. The mean pretreatment level of serum creatinine in the patients with glomerulonephritis was 1.4 mg/dl. The extent of renal function in these patients at the time of their last followup was subsequently examined.

Results: Overall, 20 of 21 patients achieved renal remission. At 1 month and 6 months following study entry, the serum creatinine level in all patients either remained stable or improved. The 20 patients have now been followed up for a median time of 76 months (range 20-108 months). Only 2 patients have had a rise of >0.2 mg/dl in their creatinine level from the time of enrollment to the most recent followup examination. Of the remaining 18 patients, 12 have had stable renal function and 6 have had improvement in their creatinine levels by more than 0.2 mg/dl.

Conclusion: In this study, the use of MTX and prednisone as initial therapy for patients with WG-related glomerulonephritis and a normal or near-normal level of serum creatinine was not associated with a long-term decline in renal function.

MeSH terms

  • Adult
  • Antirheumatic Agents / therapeutic use*
  • Cohort Studies
  • Creatinine / blood
  • Female
  • Glomerulonephritis / physiopathology
  • Glucocorticoids / therapeutic use*
  • Granulomatosis with Polyangiitis / drug therapy*
  • Humans
  • Male
  • Methotrexate / therapeutic use*
  • Time Factors
  • Treatment Outcome


  • Antirheumatic Agents
  • Glucocorticoids
  • Creatinine
  • Methotrexate