[Should adult nephrotic syndrome secondary to idiopathic extramembranous glomerulonephritis be treated? An approach by decisional analysis].
Treatment of nephrotic syndrome (without renal insufficiency) due to idiopathic membranous glomerulonephritis in adults is not clearly defined. A decisional analysis was done from data published in literature in order to define the best therapeutic choice. Three therapeutic strategies were studied: corticosteroids (either 125 mg/48 h or 30 to 60 mg/24 h), alternate therapy according to Ponticelli protocol (corticosteroids and chlorambucil), abstention of therapy. The data were divided in two groups according to the time of follow-up. The first group allows a decisional analysis for a short period of time (16 to 37 months), the second group allows this analysis for a longer period of time (54 to 65 months). The results differed according to the length of post treatment follow-up. For the shorter follow-up, corticosteroids or the association corticosteroids and chlorambucil appeared to be better than no treatment. For longer follow-up, any treatment shows an advantage in comparison to abstention of therapy. Our tentative conclusion is to propose only symptomatic treatment for this disease.
Etienne
I
I
Service de Néphrologie, CHU de Rouen, France.
Moulin
B
B
Godin
M
M
Czernichow
P
P
Dubois
D
D
Dhib
M
M
Fillastre
J P
JP
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D002699:Chlorambucil / Q000008:administration & dosage / Q000627:therapeutic use; D005921:Glomerulonephritis / Q000150:complications*; D006801:Humans; D009404:Nephrotic Syndrome / Q000188:drug therapy / Q000209:etiology*
D000305:Adrenal Cortex Hormones; D002699:Chlorambucil
Faut-il traiter les syndromes néphrotiques de l'adulte secondaires à une glomérulonéphrite extramembraneuse idiopathique? Une approche par analyse de décision.