| Abstract: | Sixty-six patients of all ages whose renal biopsy appearancessatisfied strict criteria for the histopathological diagnosisof membranous nephropathy were studied and followed for a meanof 5-4 years (range 1 to 20 years). From initial investigationseven patients were found to have associated neoplasia, andin two patients the condition followed treatment with a mercurialdiuretic and gold. One patient was Australia antigen positive.Two patients developed renal vein thrombosis, but in both thisappeared to follow not precede their nephrotic syndrome. Inthe remaining 56 patients there was no associated factor. During the follow-up period, approximately one-quarter of thepatients (15) died, nine from renal failure; one-quarter (10)had a persistent nephrotic syndrome, another one-quarter (15)proteinuria of lesser degree. The final one-quarter (16) arenow in complete remission. The prognosis of the 54 patientswith an initial nephrotic syndrome was poorer than the 12 withlesser proteinuria and no oedema at onset; five of 11 childrenwere in complete remission when last seen. All but one of thenine patients who developed terminal chronic renal failure 4to 18 years from onset had an unremitting nephrotic syndrome,and eight of the 10 currently alive with a persistent nephroticsyndrome have reduced renal function. Renal functional deteriorationdid not occur in the absence of proteinuria. There was only slight correspondence between the stage of biopsyappearance, glomerular filtration rate at time of biopsy, timeof the biopsy from apparent onset, or status at last follow-up.Staging is therefore of limited prognostic value. Twenty-twopatients were treated with corticosteroids for 2 to 36 months;we detected no short or long-term benefit when compared to patientsnot so treated.
1Present address: Princess Alexandra Hospital, Ipswich Road,Woolloongabba, Brisbane, Queensland, Australia. |
