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High-Dose Immunoglobulin Therapy for Severe IgA Nephropathy and Henoch-Schonlein Purpura

Guy Rostoker, MD, PhD; Dominique Desvaux-Belghiti, MD; Yannick Pilatte, PhD; Max Petit-Phar, MD; Claude Philippon, MD; Lionel Deforges, MD; Helene Terzidis, PhD; Liliane Intrator, MD; Chantal Andre, MD; Serge Adnot, MD, PhD; Philippe Bonin, MD, PhD; Philippe Bierling, MD; Philippe Remy, MD; Gilbert Lagrue, MD; Philippe Lang, MD; and Bertrand Weil, MD
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From Hopital Henri Mondor, Creteil, France. Requests for Reprints: Guy Rostoker, MD, PhD, Service de Nephrologie, Hopital Henri Mondor, 51 Avenue du General De Lattre De Tassigny, 94010 Creteil, France. Acknowledgments: The authors thank Drs. Gilles Avenard, Francoise Peltier-Pujol, and Clotilde Bremard-Oury for technical assistance. Grant Support: By INSERM, AURA, Universite Paris XII Val-de-Marne.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1994;120(6):476-484. doi:10.7326/0003-4819-120-6-199403150-00005
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Objective: To determine if polyvalent IgG is promising therapy for severe IgA 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-Schonlein 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.


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Figure 3.
Change in glomerular filtration rate during high-dose immunoglobulin therapy in patients with deteriorating renal function.2Table 1

The glomerular filtration rate is expressed on the vertical axis in mL/min per 1.73 m . The Y axis represents the time before and after the intervention, expressed in months. The latest data available on renal function for each patient are given. Patients 4 and 11 are omitted because their renal function was normal and stable before and after intervention. Patient 5 is omitted because we had no data earlier than 1 month before immunoglobulin therapy (see ).

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Figure 2.
Monthly rate of decline in renal function during high-dose immunoglobulin therapy.2Table 1

The rate of decline in renal function was evaluated as the decrease in the glomerular filtration rate during the period studied (mL/min per 1.73 m per number of months). Values for each patient before and after intervention are given on the vertical axis. The evaluation of the decline in renal function after intervention accounted for the latest data available for each patient. Patient 5 was omitted because we have no follow-up data on renal function more than 1 month before immunoglobulin therapy (see ).

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Figure 1.
Changes in the histologic activity index during high-dose immunoglobulin therapy.

The activity index is noted on a final 14-point scale. Values for each patient before and after intervention are given on the vertical axis.

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