| Abstract: | Twenty-one patients with membranous nephro pathy, heavy proteinuriaand progressive renal fail ure were treated with alternatingmonthly cycles of corticosteroids and chlorambucil for six months.Four patients received repeat courses. After a median periodof follow-up of 39 months, three patients had died, six werereceiving renal replace ment therapy or had serum creatinine> 500 µmol/l, and one had progressive renal failure.Eleven patients had either stable or improved renal func tion,as judged by serum creatinine concentration. Of these eleven,four patients were in partial remis sion (daily protein excretion0.2–2.0 g), and two were in complete remission. Therewas a tendency for those who received intravenous methylprednisolone to have a more favourable outcome. There was a high incidenceof side-effects, with significant complications related to drugtherapy observed in >50% of subjects. Although individualpatients appeared to respond well, sometimes dramatically, theseresults are less encouraging than other reports. We would urgecaution in the use of this form of therapy, particularly inolder patients who may have occult neoplasms, impaired glucoseintolerance or pre–existing cardiac disease. |
