Idiopathic Membranous Nephropathy

The clinical and histopathological features of 37 patients withidiopathic membranous nephropathy are presented. Males werefour times as commonly affected as females and the age at presentationranged from nine to 70 years. The period of observation variedfrom three months to 23 years. Twenty-eight patients (76 percent)presented with the nephrotic syndrome and nine patients (24per cent) presented with non-nephrotic proteinuria. At the endof the study, of the patients presenting with the nephroticsyndrome, seven (25 per cent) were in remission, seven (25 percent) remained nephrotic, nine (32 per cent) showed only proteinuriaand five (18 per cent) were dead or on dialysis. Altogethereight patients (28 per cent) developed renal failure. The ninepatients who presented with non-nephrotic proteinuria appearedto do better, and none developed renal failure. The occurrence of spontaneous remission makes assessment ofbenefit from immunosuppressivet herapy difficult. However, analysisof our data and a review of the literature suggest that in thiscondition oral prednisone, cyclophosphamide and azathioprinehave no significant therapeutic properties. Histological assessment confirmed the occurrence of mild (Grade1) changes in patients biopsied soon after presentation, andtubular atrophy increased with the duration of illness. Immunofluorescenceconfirmed deposition of mainly IgG and complement. Repeat biopsiesin 14 patients showed no histological improvement and remissionwas not accompanied by resolution of histological abnormalities.