Two-year experience with immunosuppressive treatment of chronic glomerular diseases

Abstract

The authors describe their two-year experience in the treatment of chronic glomerular diseases with cytostatic immunosuppressive agents. Cyclophosphamide, imuran and chloraminophene were used in low doses for an average of 6 months. A total of 25 patients have been treated, including 17 with various anatomic-clinical forms of chronic glomerulonephritis and 7 with secondary glomerular lesions due to systemic diseases: SLE, polyarteritis nodosa, amyloidosis. Remission was observed in 8 patients, improvement in 14, no effect in 3. The best results were observed in the cases of membranous glomerulonephritis, intracapillary proliferative glomerulonephritis and lupus nephritis. In the cases with good response, the nephrotic syndrome, haematuria, renal function, hypertension and immunologic parameters were favourably influenced. The immunosuppressive agents have the value of a causal kind of treatment. They offer new possibilities in the management of more severe and progressive cases of chronic glomerular diseases resistant to classical methods of treatment and to corticosteroids.In the last years interest has developed in the possibility of suppressing pathologically increased immune reactions by means of chemotherapeutic cytostatic agents. This new trend was determined by the progress in the study of the cellular mechanisms of immunity. The leading role of the immunccompetent lymphocytes and the process of their transformation into "immunoblasts" were established [5]. It was found that the immunoblasts display morphologic, staining and cytochemical features which are peculiar to the immature blast ceils. This fact suggested that they might be influenced by cytostatic agents. The remarkable experimental studies carried out in the late fifties and early sixties [11,16, 20,21 ] confirmed that 6-mercaptopurine and some other antimetabolites could suppress the production of antibodies, could alter the delayed (tuberculin-type) hypersensitivity and could prolong the survival of homografts.These promising experimental results were followed by the introduction of certain cytostatic agents as immunosuppressive drugs in organ transplantation and in the treatment of many diseases with confirmed or assumed immune or autoimmune character.The creation of new experimental models of iso-and autoimmune glomerulonephritis [8,9], the study of the similarity between primary glomerulonephritis and renal lesions in typical autoimmune diseases, the demonstration of circulatins anti-kidney antibodies, the use of combined electron microscopic and immunofluorescent examination of renal biopsy material, the dosage of the serum comple- Urology and Nephrology 1, 1969