Infectious complications in the management of systemic vasculitis and rapidly progressive glomerulonephritis

Patients with microscopic polyarteritis and Wegener's granulomatosis are often elderly. At present 10-20% of these patients will die from infection in the first three months of immunosuppressive treatment. Therapeutic strategies initially must maximize anti-inflammatory and immunosuppressive effects and minimize the later in the longer term. Regimens with pulse MP combined with low dose prednisolone (ie 20 mg/day), together with oral or pulsed cyclophosphamide in the first weeks followed by maintenance treatment with azathioprine and prednisolone are suggested--with PE reserved for those requiring dialysis, lung haemorrhage, or uncontrolled vasculitis.