Current pharmacotherapy for the treatment of crescentic glomerulonephritis

Abstract

Glomerulonephritis is an important cause of end-stage renal disease. Crescentic glomerulonephritis is the most severe form of glomerulonephritis and, if untreated, patients will develop renal failure within days or weeks of diagnosis. Current immunotherapy consists of corticosteroids, cytotoxic drugs and plasma exchange. Challenges include minimising toxicity of therapy, preventing relapse in antineutrophil cytoplasmic antibodies-associated vasculitis and finding an effective treatment for crescentic IgA nephropathy. There are opportunities for more specific therapies using monoclonal antibodies to T cells (and their co-stimulatory receptors), B cells and cytokines, or pharmacological inhibitors of signal transduction. Their efficacy and safety remain to be established with controlled clinical trials. Recent development of urinary cytokine measurement provides a noninvasive biomarker of renal disease activity, which is useful in monitoring response to therapy and assessing prognosis.

Keywords::

• autoimmunity
• cytokine
• glomerulonephritis
• immunosuppressive therapy
• inflammation
• p38 MAPK
• plasma exchange
• renal failure
• TNF

Acknowledgements

Research in the author’s laboratory has been supported by the Medical Research Council UK, the Wellcome Trust, Kidney Research UK, Henry Smith’s Charity, Charing Cross and Hammersmith Hospitals Renal Research Funds and Hammersmith Hospital Special Trustees. The author would like to thank J Smith for her advice on English in the preparation of this manuscript.

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