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Nephrol Dial Transplant (1989) 4: 1022-1029
© 1989 European Renal Association-European Dialysis and Transplant Association

research-article

Effectiveness of Steroid Therapy in Different Stages of Membranous Nephropathy

G. Fuiano, P. Stanziale, M. Balletta, V. Sepe, G. Marinelli, N. Comi, A. Esposito and V. E. Andreucci

Department of Nephrology, Second Faculty of Medicine Naples

Correspondence and offprint requests to: Correspondence and offprint requests to: Dr Giorgio Fuiano, Cattedra di Nefrologia Medica, Seconda Facoltà di Medicina, Via Pansini, 5, 80131 Napoli, Italy

The published studies on histological staging and response to steroid therapy of membranous glomerulonephritis are not consistent. We analysed data from 25 adult patients with stage I (group 1, n=7) and stage II (group 2, n=18) disease.

The interval between clinical onset and admission was similar in the two groups. At admission all patients had normal creatinine clearance; proteinuria averaged 5.4±4.0 in group 1 and 9.0±4.0 in group 2 (g/day per 100 ml GFR). All patients received 6 months steroid therapy (months 1–2, 1 mg/kg b.w. per day; month 3–5: 0.65 mg/kg b.w. e.o.d.; month 6, tapering).

After this cycle of steroid therapy, proteinuria declined by 84% in group 1 (five patients being in partial remission, i.e. 0.4–2 g/day, and two patients in complete remission, i.e. ≤0.3 g/day) and by 47% in group 2 (two patients being in complete remission and six in partial remission). Only 1 patient in group 1 relapsed with nephrotic proteinuria after 36 months, and renal function was still normal in all patients at the most recent follow-up (59±32 months). In contrast, 14 patients in group 2 had nephrotic syndrome and seven renal insufficiency at the most recent follow-up.

We conclude that short-term steroid therapy is effective only in patients with early membranous changes.

Keywords: Membranous nephropathy; Steroid therapy; Histological stages


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