Methylprednisolone IV Pulse (Nephrology)

How it works

As a synthetic corticosteroid, it binds glucocorticoid receptors to broadly suppress inflammatory and immune responses, reducing cytokine production and inflammatory cell activity.

Prescribing in practice

• High-dose pulses can cause serious acute effects including hyperglycaemia, hypertension, fluid retention, infection risk and, rarely, arrhythmia, so patients require close monitoring during and after infusion.
• Screen for and manage active infection before pulsing, and consider gastroprotection and bone protection as appropriate.
• It is given intravenously, usually over consecutive days, under specialist supervision.

Monitoring

Monitor blood pressure, blood glucose, fluid balance, electrolytes and for signs of infection during and following pulse therapy.

Counselling the patient

• You may notice flushing, a metallic taste, raised blood sugars or sleep disturbance around the infusions.
• Report fever or other signs of infection promptly, as steroids increase infection risk.
• Do not stop any prescribed continuing steroid abruptly without medical advice.

Evidence & guidelines

Pulsed methylprednisolone is a standard component of induction immunosuppression for severe ANCA-associated vasculitis and rapidly progressive glomerulonephritis.