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

Abstract

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.

Lymphangiography and Lymphatic Interventions

“…Surgical diversion of lymph from thoracic duct has been used by many authors in the past to treat symptoms of organ rejection and improve the condition of patients with autoimmune disorders (such as rheumatoid arthritis, systemic lupus erythematosus, myasthenia gravis, and multiple sclerosis). [28][29][30][31][32][33][34][35][36][37] Similarly, the drainage of lymph in patients with right heart failure and liver cirrhosis has shown significant improvement in symptoms postprocedure.…”