Clinical outcome assessment of membranous nephropathy

Appropriate treatment of idiopathic membranous nephropathy (IMN) remains a controversial issue. Whereas some authors recommend a conservative approach, based on the considerable rate of spontaneous remissions, others utilize early immunosuppressive treatment for most nephrotic patients with IMN. Our retrospective study consisted of 34 patients who presented with IMN between the period from 1987 to 2002. The patients were divided into two groups based on the type of treatment they received the immunosuppressive group comprised 18 patients who received corticosteroids with/without other immunosuppressive drugs and the supportive group comprised 16 patients who were treated with anti platelet drugs as supportive therapy. The amount of proteinuria at the base line was significantly higher in the immunosuppressive group than in the supportive group(4.7 +/- 2.9 vs. 2.7 +/- 2.7 g/24 h). At the end of the follow-up, complete remission was achieved more frequently in the immunosuppressive group than in the supportive group(9/18 vs. 3/16). This suggests that immunosuppressive treatment has the effect of decreasing proteinuria. At the end of the follow-up, 3 patients in the immunosuppressive group and 2 patients in the supportive group showed renal insufficiency (serum creatinine concentration > or = 1.5 mg/dl). Side effects besides diabetes were not seen as a result of immunosuppressive treatment. Our findings suggest that immunosuppressive treatment in IMN cases appears to be beneficial for decreasing proteinuria, but the effect on prevention of renal failure was not evident.