Plasma Exchange and Immunosuppression for Rapidly Progressive Glomerulonephritis: Prognosis and Complications

Rapidly progressive glomerulonephritis frequently leads to deathor dialysis. In 21 cases treated by plasma exchange and immunosuppressionwe observed seven deaths, with 12 others progressing to chronicrenal failure within 3 months. Patients who died were olderthan those who survived (57.5±17.7 vs 40.5±16.5years, mean ±SD, P=0.05), but had similar clinical symptoms(hypertension, haematuria, proteinuria, extrarenal signs) andbiochemical presentation (initial creatininaemia). They requiredthe same degree of haemodialysis, of plasma exchanges and ofbolus methylprednisolone. The causes of death were infection(three cases), cardiac arrhythmia (two cases) and gastrointestinalbleeding (two cases). Among the 14 remaining patients, onlytwo recovered normal renal function. Twelve had chronic renalfailure, six of them requiring chronic dialysis or transplantation.Severe renal failure at entry and anuria were more frequentlyobserved in patients whose renal function did not improve duringtreatment. Plasma exchange and steroid bolus infusions alsoseemed to have a beneficial effect on renal function.