Effects of methylprednisolone and cyclophosphamide pulse therapy on renal infiltrating cells in patients with crescentic glomerulonephritis
Tang, Z.; Zhou, H.; Yao, X.; Hu, W.; Leishi, L.
Chinese Medical Journal 110(3): 206-209
1997
ISSN/ISBN: 0366-6999 PMID: 9594342 Document Number: 471084
Objective: To investigate the effects of pulse methylprednisolone (MP) and monthly intravenous cyclophosphamide (CTX) therapy (MP+CTX) on renal infiltrating cells in patients with rapid progressive glomerular nephritis (RPGN). Methods: Twelve patients with RPGN ( gt 50% crescents) were given MP+CTX therapy and received repeated renal biopsies within 4 to 12 weeks after MP+CTX treatment. Seven were diagnosed as type II RPGN, including one case of IgA nephropathy, 2 cases of idiopathic RPGN and 4 cases of lupus nephritis and five were diagnosed as type III RPGN, including 2 cases of idiopathic RPGN and 3 cases of vasculitis. The changes of infiltrating CD4+, CD8+, CD68+ and proliferating cell nuclear antigen-PCNA+ cell levels were determined by four PAP method in glomeruli and interstitium. Results: In the patients before MP+CTX therapy, there were higher levels of infiltrating CD4+ and CD8+ cells (306 +- 118 and 223 +- 98.4 Num/mm-2) in renal interstitium, CD68+ cells (17.2 +- 9.95 Num/G) in glomeruli and (1120 +- 229 Num/mm-2) in interstitium, and PCNA+ cells (7.56 +- 3.57 Num/G) in glomeruli and (17.6 +- 6.85 Num/mm-2) in interstitium as compared with those in the patients after MP + CTX therapy (CD4+/CD8+ cells were 171 +- 87. 5/121 +- 38.4 Num/mm-2, CD68+ cells were 9.04 +- 4.33 Num/G and 600 +- 107 Num/mm-2, and PCNA+ cells were 2.04 +- 1.43 Num/G and 9.40 +- 4.45 Num/mm-2). These changes were associated with improving renal dysfunctions (the levels of serum creatinine and proteinuria decreased gradually from 766 +- 356 to 284 +- 192 mu-mol/L and 2.60 +- 1.46 to 1.29 +- 0.85 g/day). Conclusions: Our data indicate that the renal infiltrating cells may play an important role in renal injury in patients with RPGN. The effects of MP + CTX therapy on improving renal dysfunctions may partially contribute to its amelioration of infiltrating cells in renal tissues. The degrees of CD4+, CD68+, and PCNA+ cells in the kidney may be useful indicators of MP + CTX therapy for RPGN.