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Steroid-Resistant Idiopathic Nephrotic Syndrome: Results of Azathioprine Treatment in Adults

Steroid-Resistant Idiopathic Nephrotic Syndrome: Results of Azathioprine Treatment in Adults Abstract Fifteen patients with idiopathic nephrotic syndrome unresponsive to steroid therapy were treated with azathioprine (4 mg/kg/ day) for periods ranging from 23 to 83 days. Pretreatment biopsies were obtained in each, and four histologic types of glomerulonephritis were found: membranous glomerulonephritis, seven patients; diffuse proliferative glomerulonephritis, four patients; focal glomerulonephritis, two patients; and lobular glomerulonephritis, two patients. None achieved complete remission; two had a partial remission with marked decrease in proteinuria, loss of edema, and increase in serum albumin to near normal levels; three others improved with a lesser decrease in proteinuria and loss of edema, but no rise in serum albumin level. Of the other ten, six remained stable, three deteriorated, and one died. Responders included two with membranous glomerulonephritis, two with proliferative glomerulonephritis, and one with lobular glomerulonephritis. Neither patient with focal glomerulonephritis responded. Azathioprine therapy may be helpful in some patients with idiopathic nephrotic syndrome unresponsive to References 1. Schreiner GE: The nephrotic syndrome , in Strauss MB, Welt LG (eds): Diseases of the Kidney , ed 2. Boston, Little Brown & Co, 1971, vol 1, pp 503-636. 2. Berman LB, Schreiner GE: Clinical and histologic spectrum of the nephrotic syndrome. Amer J Med 14:249-268, 1958.Crossref 3. Churg J, Grishman E, Goldstein MH, et al: Idiopathic nephrotic syndrome in adults: A study and classification based on renal biopsies. New Eng J Med 272:165-174, 1965.Crossref 4. Sharpstone P, Ogg CS, Cameron JS: Nephrotic syndrome due to primary renal disease in adults: Survey of incidence in southeast England. Brit Med J 2:533-535, 1969.Crossref 5. Nesson HR, Sproul LE, Reiman AS, et al: Adrenal steroids in the treatment of idiopathic nephrotic syndrome in adults. Ann Intern Med 58:268-277, 1963.Crossref 6. Miller RB, Harrington JT, Ramos CP, et al: Long-term results of steroid therapy in adults with idiopathic nephrotic syndrome. Amer J Med 46:919-929, 1969.Crossref 7. Hardwicke J, Blainer JD, Brewer DB, et al: The nephrotic syndrome , in Becker EL (ed): Proceedings of the Third International Congress on Nephrology , New York, S Karger, 1966, vol 3, pp 69-82. 8. Dixon FJ, Feldman DJ, Vazquez JJ: Experimental glomerulonephritis: The pathogenesis of a laboratory model resembling the spectrum of human glomerulonephritis. J Exper Med 113:899-920, 1961.Crossref 9. Lerner RA, Glassock RJ, Dixon FJ: The role of antiglomerular basement membrane antibody in the pathogenesis of human glomerulonephritis. J Exper Med 126:989-1004, 1967.Crossref 10. Dixon FJ: The pathogenesis of glomerulonephritis. Amer J Med 44:493-499, 1968.Crossref 11. White RHR, Cameron JS, Trounce JR: Immunosuppressive therapy in steroid-resistant proliferative glomerulonephritis accompanied by the nephrotic syndrome. Brit Med J 2:853-860, 1966.Crossref 12. Michael AF, Vernier RL, Drummond KN, et al: Immunosuppressive therapy of chronic renal disease. New Eng J Med 276:817-829, 1967.Crossref 13. Maher JF, Schreiner GE: Treatment of lupus nephritis with azathioprine. Arch Intern Med 125:293-298, 1970.Crossref 14. Moncrief MW, White RHR, Ogg CS, et al: Cyclophosphamide therapy in the nephrotic syndrome in childhood. Brit Med J 1:666-671, 1969.Crossref 15. Guber M, Paronetto F: IgE and glomeruli of patients with nephrotic syndrome. Lancet 1:1097-1099, 1971. 16. McCluskey RT, Vassalli P, Gallo G, et al: An immunofluorescent study of pathogenic mechanisms in glomerular disease. New Eng J Med 274:695-701, 1966.Crossref 17. Makinodan T, Santos GW, Quinn RP: Immunosuppressive drugs. Pharmacol Rev 22:180-242, 1970. 18. Herdman RC, Michael AF, Good RA: Immunosuppressive and anticoagulant therapy of renal disease , Proceedings of the Fourth International Congress on Nephrology , 1969, vol 3, pp 62-71. 19. Chasis H, Goldring W, Baldwin DS: Effect of febrile plasma, typhoid vaccine and nitrogen mustard on renal manifestations of human glomerulonephritis. Proc Soc Exp Biol Med 71:565-567, 1949.Crossref 20. Baldwin DS, McLean PG, Chasis H, et al: Effect of nitrogen mustard on the clinical course of glomerulonephritis. Arch Intern Med 92:162-167, 1953.Crossref 21. Krueger RP, Gunnells JC: Azathioprine therapy of renal disease, (abstracted). Clin Res 17:52, 1969. 22. Adams DA, Gordon A, Maxwell MH: Azathioprine treatment of immunological renal disease. JAMA 199:459-463, 1967.Crossref 23. Sharpstone P, Ogg CS, Cameron JS: Nephrotic syndrome due to primary renal disease in adults: II. A controlled trial of prednisone and azathioprine. Brit Med J 2:535-539, 1969.Crossref 24. Booth LJ, Aber GM: Immunosuppressive therapy in adults with proliferative glomerulonephritis: Controlled trial. Lancet 2:1010-1013, 1970.Crossref 25. Bardona EJ, Porter GA, Pirofsky B, et al: Azathioprine in steroid-insensitive nephropathy. Amer J Med 49:789-800,1970.Crossref 26. Treatment of the nephrotic syndrome, editorial. Brit Med J 3:58-59,1970. 27. Rose GA, Black DAK: Controlled trial of steroids in nephrotic syndrome. Quart J Med 36:607, 1967. 28. Cameron JS: Glomerulonephritis. Brit Med J 4:285-289, 1970.Crossref 29. Swanson MA, Schwartz RS: Immunosuppressive therapy: The relation between clinical response and immunologic competence. New Eng J Med 277:164-170, 1967.Crossref 30. Drinkard JP, Stanley TM, Dornfeld L, et al: Azathioprine and prednisone in the treatment of adults with lupus nephritis. Medicine 49:411-432, 1970.Crossref 31. Borel Y, Schwartz R: Inhibition of immediate and delayed hypersensitivity in rabbit by 6-mercaptopurine. J Immunol 92:754-761, 1964. 32. Page AR, Condie RM, Good RA: Effect of 6-mercaptopurine on inflammation. Amer J Path 40:519-530, 1962. 33. Dukor P, Dietrich FM: Characteristic features of immunosuppression by steroids and cytotoxic drugs. Int Arch Allerg 34:32-48, 1968.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Steroid-Resistant Idiopathic Nephrotic Syndrome: Results of Azathioprine Treatment in Adults

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Publisher
American Medical Association
Copyright
Copyright © 1972 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1972.03650060067011
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Abstract

Abstract Fifteen patients with idiopathic nephrotic syndrome unresponsive to steroid therapy were treated with azathioprine (4 mg/kg/ day) for periods ranging from 23 to 83 days. Pretreatment biopsies were obtained in each, and four histologic types of glomerulonephritis were found: membranous glomerulonephritis, seven patients; diffuse proliferative glomerulonephritis, four patients; focal glomerulonephritis, two patients; and lobular glomerulonephritis, two patients. None achieved complete remission; two had a partial remission with marked decrease in proteinuria, loss of edema, and increase in serum albumin to near normal levels; three others improved with a lesser decrease in proteinuria and loss of edema, but no rise in serum albumin level. Of the other ten, six remained stable, three deteriorated, and one died. Responders included two with membranous glomerulonephritis, two with proliferative glomerulonephritis, and one with lobular glomerulonephritis. Neither patient with focal glomerulonephritis responded. Azathioprine therapy may be helpful in some patients with idiopathic nephrotic syndrome unresponsive to References 1. Schreiner GE: The nephrotic syndrome , in Strauss MB, Welt LG (eds): Diseases of the Kidney , ed 2. Boston, Little Brown & Co, 1971, vol 1, pp 503-636. 2. Berman LB, Schreiner GE: Clinical and histologic spectrum of the nephrotic syndrome. Amer J Med 14:249-268, 1958.Crossref 3. Churg J, Grishman E, Goldstein MH, et al: Idiopathic nephrotic syndrome in adults: A study and classification based on renal biopsies. New Eng J Med 272:165-174, 1965.Crossref 4. Sharpstone P, Ogg CS, Cameron JS: Nephrotic syndrome due to primary renal disease in adults: Survey of incidence in southeast England. Brit Med J 2:533-535, 1969.Crossref 5. Nesson HR, Sproul LE, Reiman AS, et al: Adrenal steroids in the treatment of idiopathic nephrotic syndrome in adults. Ann Intern Med 58:268-277, 1963.Crossref 6. Miller RB, Harrington JT, Ramos CP, et al: Long-term results of steroid therapy in adults with idiopathic nephrotic syndrome. Amer J Med 46:919-929, 1969.Crossref 7. Hardwicke J, Blainer JD, Brewer DB, et al: The nephrotic syndrome , in Becker EL (ed): Proceedings of the Third International Congress on Nephrology , New York, S Karger, 1966, vol 3, pp 69-82. 8. Dixon FJ, Feldman DJ, Vazquez JJ: Experimental glomerulonephritis: The pathogenesis of a laboratory model resembling the spectrum of human glomerulonephritis. J Exper Med 113:899-920, 1961.Crossref 9. Lerner RA, Glassock RJ, Dixon FJ: The role of antiglomerular basement membrane antibody in the pathogenesis of human glomerulonephritis. J Exper Med 126:989-1004, 1967.Crossref 10. Dixon FJ: The pathogenesis of glomerulonephritis. Amer J Med 44:493-499, 1968.Crossref 11. White RHR, Cameron JS, Trounce JR: Immunosuppressive therapy in steroid-resistant proliferative glomerulonephritis accompanied by the nephrotic syndrome. Brit Med J 2:853-860, 1966.Crossref 12. Michael AF, Vernier RL, Drummond KN, et al: Immunosuppressive therapy of chronic renal disease. New Eng J Med 276:817-829, 1967.Crossref 13. Maher JF, Schreiner GE: Treatment of lupus nephritis with azathioprine. Arch Intern Med 125:293-298, 1970.Crossref 14. Moncrief MW, White RHR, Ogg CS, et al: Cyclophosphamide therapy in the nephrotic syndrome in childhood. Brit Med J 1:666-671, 1969.Crossref 15. Guber M, Paronetto F: IgE and glomeruli of patients with nephrotic syndrome. Lancet 1:1097-1099, 1971. 16. McCluskey RT, Vassalli P, Gallo G, et al: An immunofluorescent study of pathogenic mechanisms in glomerular disease. New Eng J Med 274:695-701, 1966.Crossref 17. Makinodan T, Santos GW, Quinn RP: Immunosuppressive drugs. Pharmacol Rev 22:180-242, 1970. 18. Herdman RC, Michael AF, Good RA: Immunosuppressive and anticoagulant therapy of renal disease , Proceedings of the Fourth International Congress on Nephrology , 1969, vol 3, pp 62-71. 19. Chasis H, Goldring W, Baldwin DS: Effect of febrile plasma, typhoid vaccine and nitrogen mustard on renal manifestations of human glomerulonephritis. Proc Soc Exp Biol Med 71:565-567, 1949.Crossref 20. Baldwin DS, McLean PG, Chasis H, et al: Effect of nitrogen mustard on the clinical course of glomerulonephritis. Arch Intern Med 92:162-167, 1953.Crossref 21. Krueger RP, Gunnells JC: Azathioprine therapy of renal disease, (abstracted). Clin Res 17:52, 1969. 22. Adams DA, Gordon A, Maxwell MH: Azathioprine treatment of immunological renal disease. JAMA 199:459-463, 1967.Crossref 23. Sharpstone P, Ogg CS, Cameron JS: Nephrotic syndrome due to primary renal disease in adults: II. A controlled trial of prednisone and azathioprine. Brit Med J 2:535-539, 1969.Crossref 24. Booth LJ, Aber GM: Immunosuppressive therapy in adults with proliferative glomerulonephritis: Controlled trial. Lancet 2:1010-1013, 1970.Crossref 25. Bardona EJ, Porter GA, Pirofsky B, et al: Azathioprine in steroid-insensitive nephropathy. Amer J Med 49:789-800,1970.Crossref 26. Treatment of the nephrotic syndrome, editorial. Brit Med J 3:58-59,1970. 27. Rose GA, Black DAK: Controlled trial of steroids in nephrotic syndrome. Quart J Med 36:607, 1967. 28. Cameron JS: Glomerulonephritis. Brit Med J 4:285-289, 1970.Crossref 29. Swanson MA, Schwartz RS: Immunosuppressive therapy: The relation between clinical response and immunologic competence. New Eng J Med 277:164-170, 1967.Crossref 30. Drinkard JP, Stanley TM, Dornfeld L, et al: Azathioprine and prednisone in the treatment of adults with lupus nephritis. Medicine 49:411-432, 1970.Crossref 31. Borel Y, Schwartz R: Inhibition of immediate and delayed hypersensitivity in rabbit by 6-mercaptopurine. J Immunol 92:754-761, 1964. 32. Page AR, Condie RM, Good RA: Effect of 6-mercaptopurine on inflammation. Amer J Path 40:519-530, 1962. 33. Dukor P, Dietrich FM: Characteristic features of immunosuppression by steroids and cytotoxic drugs. Int Arch Allerg 34:32-48, 1968.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Dec 1, 1972

References