Glomerulonephritis / Vasculitis Pregnancy: Use with caution — benefit may outweigh risk in severe renal disease; neonatal adrenal suppression if used near term

Methylprednisolone IV Pulse (Nephrology)

Brand names: Solu-Medrone

Adult dose

Dose: 500-1000 mg IV once daily for 3 consecutive days

Route: Intravenous infusion over 30-60 minutes

Frequency: Daily for 3 days (pulse course)

Max: 1000 mg per pulse dose

For rapidly progressive glomerulonephritis, ANCA vasculitis, severe lupus nephritis, acute transplant rejection. Infuse over minimum 30 minutes — rapid infusion (<10 min) associated with cardiac arrhythmia and sudden death.

Paediatric dose

Dose: 10-30 mg/kg

Route: IV infusion over 30-60 minutes

Frequency: Daily for 3 days

Max: 1000 mg per dose

Monitor ECG and electrolytes during infusion in children — cardiac arrhythmia risk with rapid infusion.

Dose adjustments

Renal

No dose adjustment required — used specifically in severe renal disease. Monitor fluid balance and BP closely.

Hepatic

No dose adjustment required

Paediatric weight-based calculator

Patient weight (kg)

Monitor ECG and electrolytes during infusion in children — cardiac arrhythmia risk with rapid infusion.

Clinical pearls

Infusion rate is CRITICAL: minimum 30-60 minutes. Cases of fatal cardiac arrhythmia and arrest reported with rapid IV push. Use cardiac monitoring in elderly/cardiac history patients.
Hyperglycaemia: peaks 4-8 hours post-infusion — variable-rate insulin protocol may be needed in diabetics or post-transplant patients
Infection screening before pulse therapy: Quantiferon-TB Gold, Hepatitis B/C, CMV — reactivation can be fatal in immunosuppressed patients
Bone protection: if prednisolone equivalent >7.5 mg/day for >3 months — start calcium + vitamin D + bisphosphonate (NICE NG187)
Avascular necrosis: cumulative steroid exposure is the key risk factor. Hip pain during or after treatment = urgent MRI; early diagnosis allows joint preservation.

Contraindications

Systemic infection (unless treated)
Live vaccines within 3 months
Rapid infusion <10 minutes (arrhythmia risk)

Side effects

Hypertension, hyperglycaemia, fluid retention
Psychiatric disturbance
Facial flushing, metallic taste
Cardiac arrhythmia (if infused rapidly)
PCP reactivation
Avascular necrosis of femoral head
Adrenal suppression

Interactions

CYP3A4 inhibitors (ketoconazole) — increase steroid levels
CYP3A4 inducers (rifampicin) — reduce efficacy
Warfarin — variable INR
Live vaccines — contraindicated

Monitoring

Blood glucose (4-8 hours post-infusion)
Blood pressure
ECG (first infusion in elderly/cardiac history)
Potassium (hypokalaemia with pulses)
Infection signs
eGFR

Reference: BNFc; BNF 90; KDIGO Vasculitis 2021; KDIGO Lupus Nephritis 2021; NICE NG232; SPC Solu-Medrone. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways