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

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 8 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. Copyright (c) 2006 S. Karger AG, Basel.