Azathioprine treatment of immunological renal disease

In 17 patients, active (diffuse) lupus glomerulonephritis was treated with a combination of mechlorethamine (HN₂) and a high dose of corticosteroids (HDS). Serial clinical and sequential histologic observations were made. The results were compared with those from a previously reported and comparable group of patients who were treated with HDS alone. The mortality rate seen in the more severely affected patients was similar in both groups and there was no significant difference in estimated survival. By contrast, in those in whom the kidneys were less severely affected, the estimated survival appeared to be better in those treated with HDS-HN₂. Control of histologic activity also occurred more rapidly in the HDS-HN₂ group.

Section: Discussionmentioning

confidence: 99%

The Effect of Treatment with Prednisone and Nitrogen Mustard on the Renal Lesions and Life Span of Patients with Lupus Glomerulonephritis

Dillard¹,

Dujovne²,

Pollak³

et al. 1973

“…As antimetabolites have been reported to have a salubrious effect in patients with SLE [2,6,7,9,14,16,40] as well as in a variety of other 'auto immune' diseases [2,6,7,14,16,25,26,36,39] and have proven effective in preventing or minimizing damage in transplanted kidneys [5,13,35], it seemed reasonable to us, as it has to others [16,30,33,40], to use azathioprine in the treatment of a group of patients with active proliferative glomerulo nephritis due to SLE.…”

mentioning

confidence: 99%

Comparison of Azathioprine, Prednisone, and Heparin Alone or Combined in Treating Lupus nephritis

Cade

Spooner

Schlein

et al. 1973

139

50 patients with proliferative glomerulonephritis due to lupus erythematosus were assigned in order of their chronologic appearance at the hospital alternately to treatment with either daily high dose prednisone, azathioprine, prednisone and azathioprine combined, or combined azathioprine and heparin. Prednisone alone was ineffective both from a standpoint of maintaining kidney function or from preserving a state of well being. Only 2 of 15 patients treated with prednisone are doing well with an average survival for the group of 19 months. Azathioprine, alone, appeared very effective with 9 of 13 patients alive and doing well with an average survival of 38 months. Combinations of either azathioprine and prednisone or azathioprine and heparin were most successful, only 2 of 13 in each group died of renal failure. Complications of prednisone administra’ion were high both when prednisone was given alone or in combination with azathioprine.

“…It has not been explained why Azathioprine was so irregularly effective in patients with glomerulo nephritis. It may be [2] that some forms of the disease are not due to immunological processes, that antigen antibody complexes may da mage the kidney initially but are not able to sustain injurious immune …”

Section: Discussionmentioning

confidence: 99%

Immunosuppressive Drugs and Lymphatic Depletion by Thoracic Duct Fistula in Adult Progressive Glomerulonephritis

Bonomini¹,

Mioli²,

Albertazzi³

et al. 1970

The results of clinical, functional and renal biopsy follow-up studies performed in 2 series of adult patients with glomerulonephritis are reported. The first series included 35 cases which were divided into 4 groups according to the histological picture, namely cases with ‘minimal’, ‘proliferative’, ‘membranous’ and ‘chronic’ lesions. These cases were treated with Azathioprine alone (16 cases) or combined with prednisone (19 cases) for 1 to 2 years. A true recovery-rate (based on the disappearance of the clinical, biochemical and renal biopsy lesions) was found in 31,4% of the cases. The second series consisted of 15 immunosuppressive-resistant cases. A lymphatic depletion was obtained by Thoracic Duct Fistula, and was estimated as satisfactory in 11 of the cases with an average output per fistula of 50 × 10⁹ lymphocytes and 36,91 g of immunoglobulins. Post-fistula immunosuppressive therapy was in each case the same as the pre-fistula one. Three cases completely recovered, 4 cases improved, 4 cases were unchanged. Some hypotheses able to account for the observed results are discussed.