HIGH-DOSE IMMUNOGLOBULIN THERAPY FOR SEVERE IGA NEPHROPATHY AND HENOCH-SCHONLEIN PURPURA

Objective: To determine if polyvalent IgG is promising therapy for severe IgA nephropathy. Design: Open prospective cohort study. Setting: Referral nephrology unit. Patients: 11 adult patients with severe IgA nephropathy (9 who had idiopathic disease and 2 who had Henoch-Schanlein purpura) and indicators of poor prognosis. Intervention: Patients were given high-dose immunoglobulins (2 g/kg each month) for 3 successive months, followed by intramuscular immunoglobulins (preparation content, 16.5%; 0.35 mL/kg every 15 days) for another 6 months. Measurements: Histologic changes were analyzed by comparing pre- and post-therapy renal biopsy specimens blindly, using an activity index (14-point scale), a sclerosis index (10-point scale), and a semiquantitative immunofluorescence test of immune deposits. Proteinuria, hematuria, leukocyturia, enzymuria, and global renal function (creatinine and polyfructosan clearances) were evaluated before and after intervention. Results: Proteinuria (median level before intervention, 5.20 g/d; median level after intervention, 2.25 g/d), hematuria, and leukocyturia decreased substantially. The decrease in glomerular filtration rate was greatly slowed or stopped (median rate of decline in glomerular filtration before, -3.78 mL/min per month; after, 0 mL/min per month). The histologic index of activity (median index before, 5; after, 2) and the staining intensity of glomerular IgA and C3 deposits also decreased. Immunoglobulin therapy was well tolerated. Conclusions: Immunoglobulin therapy may be effective in treating severe IgA nephropathy and protecting renal function. However, prospective controlled trials must confirm these preliminary results.