Prednisone glomerulonephritis

Acute glomerulonephritis Prednisone,1 mercaptopurine, cyclophosphamide Usually good... 

Azathioprine and mercaptopurine appear to be of definite benefit in maintaining renal allografts and may be of value in transplantation of other tissues. These antimetabolites have been used with some success in the management of acute glomerulonephritis and in the renal component of systemic lupus erythematosus. They have also proved useful in some cases of rheumatoid arthritis, Crohn s disease, and multiple sclerosis. The drugs have been of occasional use in prednisone-resistant antibody-mediated idiopathic thrombocytopenic purpura and autoimmune hemolytic anemias. 

Other agents are effective in special populations. Vitamin K prevented bone loss in 20 patients with chronic glomerulonephritis treated with prednisolone (263) and ciclo-sporin 4.8 mg/kg/day prevented glucocorticoid-induced osteopenia in 52 patients taking prednisone 10 mg/day after kidney transplantation (264). 

Azathioprine is an effective agent in suppressing the immune system in patients undergoing renal transplantation and in patients suffering from acute glomerulonephritis, the renal component of systemic lupus erythematosus, prednisone-resistant idiopathic thrombocytopenic purpura, and functioning autoimmune hemolytic anemia. Azathioprine depresses bone marrow functioning, which is its chief side effect. 

Tarshish P, Bernstein J, Tobin JN, et al. Treatment of mesangiocapillary glomerulonephritis with alternate-day prednisone—A report of the International Study of Kidney Disease in Children. Pediatr Nephrol 1992 6 123-130. 

The development of an acute interstitial inflammatory reaction in the kidney related to the administration of certain classes of drugs and leading to renal failure has been recognized for almost a century [42]. Antibiotics, in particular the sulfonamides [43] and semisynthetic penicillins [44, 45], were recognized as etio-logically associated in many instances. A retrospective review of 1068 kidney biopsies from 1%8 to 1997 by Schwarz et al. yielded acute interstitial nephritis in 6.5% of cases. In the majority of instances (85%) acute interstitial nephritis was drug related. Diuretics were implicated in 7.8 % of these cases [46]. Lyons et al. noted that four patients with proliferative glomerulonephritis and nephrotic syndrome treated with sulfonamide-derivative diuretics (furosemide or thiazides) developed severe renal failure, which reversed when the diuretic was withdrawn and prednisone was adminis-... 

Urinary tract Hydralazine has been associated with ANCA positive pauci-immune glomerulonephritis and pulmonary alveolar hemorrhage [105 ]. In this case anti-double-stranded DNA and antihistone antibodies were present in the absence of full classification criteria for drug-induced lupus-like syndrome. The symptoms and renal function improved after withdrawal of hydralazine and a short course of cyclophosphamide and prednisone. 

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