Clinical efficacy of intravenous immunoglobulin for patients with MPO-ANCA-associated rapidly progressive glomerulonephritis

Nephron Clin Pract. 2006;102(1):c35-42. doi: 10.1159/000088313. Epub 2005 Sep 19.


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.

Conclusion: IVIg is a potential component of remission induction therapy for patients with MPO-ANCA-associated RPGN.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antibodies, Antineutrophil Cytoplasmic
  • C-Reactive Protein / analysis
  • Creatine / blood
  • Cyclophosphamide / therapeutic use
  • Cytokines / blood
  • Disease Progression
  • Drug Therapy, Combination
  • Female
  • Glomerulonephritis / drug therapy*
  • Glucocorticoids / therapeutic use
  • Humans
  • Immunoglobulins, Intravenous / therapeutic use*
  • Immunologic Factors / therapeutic use*
  • Immunosuppressive Agents / therapeutic use
  • Kidney / pathology
  • Leukocyte Count
  • Male
  • Middle Aged
  • Peroxidase
  • Prednisolone / therapeutic use
  • Remission Induction
  • Tumor Necrosis Factor-alpha / analysis


  • Antibodies, Antineutrophil Cytoplasmic
  • Cytokines
  • Glucocorticoids
  • Immunoglobulins, Intravenous
  • Immunologic Factors
  • Immunosuppressive Agents
  • Tumor Necrosis Factor-alpha
  • Cyclophosphamide
  • C-Reactive Protein
  • Prednisolone
  • Peroxidase
  • Creatine