第21卷 　 第二期 　 Vol. 21, No. 2, December, 2007

Original Aiticles 原著

Effects of the methylprednisolone pulse therapy on renal function

Chin-Hsiu Liu1, Song-Chou Hsieh2, Cheng-Han Wu2, Chia-Li Yu2

1Division of Rheumatology, Immunology, and Allergy, Department of Internal Medicine,  Buddish Xindian-Tzu-Chi General Hospital, Taipei, Taiwan 2Division of Rheumatology, Immunology, and Allergy, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

Objective: To clarify the effect of the methylprednisolone (MP) pulse therapy on renal function and analyze the risk factors. Methods: Forty-nine patients with collagen vascular diseases were included, of whom 26 patients were assigned in nephritis group with SLE or Sjögren’s syndrome and the other 23 patients were in the group without renal involvements. Results: Before the MP pulse therapy, the nephritis group showed a significantly higher prevalence of leukopenia (p=0.028), low C3/C4 (p<0.001), positive ANA (p=0.015), and positive SSA/SSB (p<0.001) when compared with the group without nephritis. After 3-consecutive-day pulse therapy of 1000 mg MP, only one patient with nephrotic syndrome and chronic renal failure suffered from deteriorated renal failure. There were no clinically significant changes on glomerular filtration rate, serum creatinine and fluid retention after MP pulse therapy in both groups. Interestingly, a trend of the increase of creatinine clearance rate (Ccr) (p=0.185) was found in nephritis group, while a trend of the decrease of Ccr (p=0.263) was found in non-nephritis group instead (though not statistically significant). We also found that albumin >3.5 mg/dL in the nephritis group before the MP pulse therapy (p=0.023) could predict the improvement of Ccr after the MP pulse therapy, which showed serum albumin level could be the most important indicator for the adverse effect on renal function during MP pulse therapy. Conclusion: Intravenous MP pulse therapy is the potent anti-inflammatory and immunosuppressive therapy for inflammatory autoimmune disease. From our finding, MP pulse therapy is effective for autoimmune diseases with renal involvement. In addition to treatment benefit, the adverse effect on renal function of MP pulse therapy is not significant if the patient’s albumin is more than 2.0 mg/dL, creatinine less than 2.0 mg/dL and Ccr more than 30 ml/min.

keyword Pulse therapy, methylprednisolone, renal failure, albumin, anti-dsDNA