Background Defining the most appropriate treatment for patientswith idiopathic membranous nephropathy is a matter of controversy.The course of the disorder is often benign, and the immunosuppressiveregimens used in some patients have uncertain benefits and substantialrisks. We studied the natural history of idiopathic membranousnephropathy in patients who received only symptomatic therapy.
Methods We prospectively studied 100 consecutive patients (68men and 32 women; mean [±SD] age, 51 ±17 years)with biopsy-proved idiopathic membranous nephropathy. The patientsreceived diuretic or antihypertensive drugs as needed, but noglucocorticoid or immunosuppressive drugs. We examined the patientsand measured their urinary protein excretion and serum creatinineconcentrations every 6 months for a mean of 52 months.
Results Twenty-four (65 percent) of the 37 patients followedfor at least five years had complete or partial remission ofproteinuria; in 6 others (16 percent), end-stage renal diseasedeveloped, and they required dialysis. As calculated by theKaplan-Meier method, the estimated probability (±thestandard error of the estimate) of retaining adequate kidneyfunction was 88 ±5 percent after five years and 73 ±7percent after eight years. The prognosis was poorer in men andin patients over 50 years of age, but not in patients with thenephrotic syndrome, hypertension, or hypercholesterolemia.
Conclusions Most untreated patients with idiopathic membranousnephropathy maintain renal function for prolonged periods andare likely to have spontaneous remission. These results do notsupport the use of glucocorticoids and immunosuppressive drugsin patients with idiopathic membranous nephropathy.
Source Information
From the Mario Negri Institute for Pharmacological Research (A.S., L.M., A.P., T.B., S.G., G.R.) and the Division of Nephrology and Dialysis, Ospedali Riuniti di Bergamo (A.S., G.M., T.B., G.R.), both in Bergamo, Italy.
Address reprint requests to Dr. Schieppati at the Mario Negri Institute for Pharmacological Research, Centro di Ricerche Cliniche per le Malattie Rare, Villa Camozzi, 24020 Ranica, Italy.
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