Clinical Nephrology – Epidemiology – Clinical Trials
Kidney International (2002) 61, 219–227; doi:10.1046/j.1523-1755.2002.00124.x
Conservative versus immunosuppressive treatment of patients with idiopathic membranous nephropathy1
Alvaro Torres, Beatriz Domínguez-Gil, Agustín Carreño, Eduardo Hernández, Enrique Morales, Julian Segura, Ester González and Manuel Praga
Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
Correspondence: Dr Manuel Praga, Servicio de Nefrología, Hospital 12 de Octubre, Carretera de Andalucía Km 5,400, 28041 Madrid, Spain. E-mail: mpragat@senefro.org
1See Editorial by Cattran, p. 349.
Received 14 May 2001; Revised 1 August 2001; Accepted 31 August 2001.
Abstract
Conservative versus immunosuppressive treatment of patients with idiopathic membranous nephropathy.
Background
Treatment of idiopathic membranous glomerulonephritis (MGN) is a controversial issue. Whereas some authors recommend early immunosuppressive treatment of all patients with nephrotic syndrome, others do not support aggressive therapies, based on the spontaneous long-term favorable outcome of most patients. However, 20 to 50% of untreated patients develop progressive renal insufficiency.
Methods
All of the patients with biopsy-proven MGN who developed renal insufficiency at our Hospital during the period of 1975 to 2000 were studied. Selected patients (N = 39) were separated into two groups according to the two different therapeutic policies followed at our department: a conservative approach during the first period, 1975 to 1989 (group I, N = 20), and a course of immunosuppressive therapy (oral prednisone for six months and concurrent oral chlorambucil, 0.15 mg/kg/day, during the first 14 weeks) during the second period, 1990 to 2000 (group II, N = 19).
Results
There were no significant differences between both groups at the time of renal biopsy, nor at the onset of renal function decline. All group I patients showed a progressive renal insufficiency; at the end of the follow-up 13 patients (65%) were on chronic dialysis, 2 (10%) showed advanced renal failure, and 5 (25%) had died. In contrast, most of group II patients showed an improvement or stabilization of serum creatinine (SCr; 2.3 
0.9 mg/dL at onset of treatment, 2 1.5 mg/dL at the end of follow-up) together with decreased proteinuria (11.2 3.3 vs. 5.2 6.7 g/24 h). At the end of the follow-up 58% of group II patients had a SCr value 
1.5 mg/dL and 36% showed a complete or partial remission, whereas no patient in group I showed remission. After four years of follow-up the probability of renal survival without dialysis was 55% in group I and 90% in group II (P < 0.001), and after seven years the renal survival was 20% and 90%, respectively (P < 0.001). Side effects of immunosuppressive treatment were uncommon but severe, as two patients suffered Pneumocystis carinii pneumonia.
Conclusion
A course of immunosuppressive treatment administered early at the onset of renal function decline induces a favorable effect in most of patients with MGN and deteriorating renal function. Untreated patients progressed without exception toward advanced renal failure.
Keywords:
nephrotic syndrome, immunosuppression, progressive renal disease, kidney deterioration, proteinuria, renal failure
