Transient renal failure following intravenous methylprednisolone pulse therapy

Abstract

The effect of intravenous methylprednisolone (MP) pulse therapy on renal function was studied in 56 patients with renal or collagen disease. We examined the correlation between the changes in serum creatinine, body weight, and urinary volume before and after pulse therapy and such other parameters as serum creatinine, total protein, albumin, and urinary sodium excretion. There was a significant correlation between the change in serum creatinine versus the change in body weight ( r = .648, P < 0.001), urinary volume ( r = −.557, P < 0.001), serum creatinine ( r = .756, P < 0.001), serum albumin ( r = −.421, P < 0.005), and urinary sodium ( r = −3.91, P < 0.05). We defined as deteriorated seven patients whose serum creatinine level rose more than 0.5 mg/dl from baseline, 1.06 mg/dl on the average, after pulse therapy. In two of the patients, the rise in serum creatinine level was acutely reversed by inducing diuresis by administering albumin and furosemide. In the other five, the serum creatinine level fell spontaneously to baseline level on discontinuance of treatment. The deteriorated patients had more severe nephrosis and renal impairment versus the nondeteriorated patients. The findings indicate that (1) the effect of MP pulse therapy on renal function depends on the patient's clinical state; and (2) the deterioration in renal function following such therapy may be more marked in those with more severe nephrosis and renal functional impairment at the outset. An increase in sodium and water retention during MP therapy and associated renal interstitial edema, which is proposed as a mechanism for acute renal failure in patients with minimal change nephrotic syndrome, may be responsible for the transient renal failure induced by MP therapy.