High-dose immunoglobulin therapy for severe IgA nephropathy and Henoch-Schönlein purpura

Ann Intern Med. 1994 Mar 15;120(6):476-84. doi: 10.7326/0003-4819-120-6-199403150-00005.

Abstract

Objective: To determine if polyvalent IgG is promising therapy for severe IgG nephropathy.

Design: Open prospective cohort study.

Setting: Referral nephrology unit.

Patients: 11 adult patients with severe IgA nephropathy (9 who had idiopathic disease and 2 who had Henoch-Schönlein purpura) and indicators of poor prognosis.

Intervention: Patients were given high-dose immunoglobulins (2 g/kg each month) for 3 successive months, followed by intramuscular immunoglobulins (preparation content, 16.5%; 0.35 mL/kg every 15 days) for another 6 months.

Measurements: Histologic changes were analyzed by comparing pre- and post-therapy renal biopsy specimens blindly, using an activity index (14-point scale), a sclerosis index (10-point scale), and a semiquantitative immunofluorescence test of immune deposits. Proteinuria, hematuria, leukocyturia, enzymuria, and global renal function (creatinine and polyfructosan clearances) were evaluated before and after intervention.

Results: Proteinuria (median level before intervention, 5.20 g/d; median level after intervention, 2.25 g/d), hematuria, and leukocyturia decreased substantially. The decrease in glomerular filtration rate was greatly slowed or stopped (median rate of decline in glomerular filtration before, -3.78 mL/min per month; after, 0 mL/min per month). The histologic index of activity (median index before, 5; after, 2) and the staining intensity of glomerular IgA and C3 deposits also decreased. Immunoglobulin therapy was well tolerated.

Conclusions: Immunoglobulin therapy may be effective in treating severe IgA nephropathy and protecting renal function. However, prospective controlled trials must confirm these preliminary results.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Female
  • Glomerulonephritis, IGA / metabolism
  • Glomerulonephritis, IGA / pathology
  • Glomerulonephritis, IGA / therapy*
  • Humans
  • IgA Vasculitis / metabolism
  • IgA Vasculitis / pathology
  • IgA Vasculitis / therapy*
  • Immunoglobulin G / administration & dosage*
  • Immunoglobulins / analysis
  • Immunoglobulins, Intravenous / therapeutic use*
  • Kidney / pathology
  • Male
  • Prospective Studies
  • Proteinuria / urine

Substances

  • Immunoglobulin G
  • Immunoglobulins
  • Immunoglobulins, Intravenous