Return of Renal Function After Renal Insufficiency With Cyclophosphamide Therapy in Wegener's Granulomatosis

To the Editor.  —Wegener's granulomatosis, first described in 1931 by Klinger¹ and further defined by Wegener in 1936,² is a well-delineated clinicopathologic entity involving necrotizing granulomatous vasculitis of the upper and lower respiratory system, glomerulonephritis, and variable degrees of widespread small-vessel vasculitis. Despite the impressive therapeutic results achieved with cyclophosphamide in this syndrome by Wolff et al,³ to our knowledge only one patient has been described to recover substantial long-term renal function after renal failure has supervened.⁴ We describe a patient with such a diagnosis initially seen with rapidly progressive renal insufficiency necessitating dialysis, treated early and aggressively, resulting in remarkable recovery of renal function. Such an outcome illustrates the importance of early intervention.

Report of a Case.  —A 70-year-old woman had normal findings from physical examination, normal chest roentgenogram, and a creatinine value of 1.0 mg/dL in September 1978. In January 1979, malaise, fatigue, decreased