title: Sustained remission of membranous glomerulonephritis after cyclophosphamide and prednisone.
abstract: OBJECTIVE
  To determine the effect of cyclophosphamide and prednisone on progressive renal failure and on nephrotic features in patients with membranous glomerulonephritis.
  
  
  METHODS
  Prospective, nonrandomized time series.
  
  
  METHODS
  Outpatient clinic at a university medical center.
  
  
  METHODS
  Eleven consecutive patients with biopsy-proven membranous glomerulonephritis and rising plasma creatinine levels over at least 6 months.
  
  
  METHODS
  Cyclophosphamide and prednisone in ten patients and cyclophosphamide alone in one patient.
  
  
  RESULTS
  In ten patients treated with both agents, the median plasma creatinine rose 53 mumol/L (0.6 mg/dL) over the months before treatment from 141 to 194 mumol/L (1.6 to 2.2 mg/dL) (95% CI, 27 to 141 mumol/L; P = 0.002). After combined therapy for 6 months, the median plasma creatinine fell to 133 mumol/L (1.5 mg/dL) for a median decline of 62 mumol/L (0.7 mg/dL) (CI, 44 to 150 mumol/L; P = 0.006). Pretreatment plasma creatinine levels, which ranged from 159 to 371 mumol/L (1.8 to 4.2 mg/dL), decreased in the ten patients by 6 months and remained stable in seven of the eight patients followed 24 to 54 months after therapy was completed. The median urine protein excretion decreased by 9.6 g/d with 12 months of therapy in the ten patients from 11.9 to 2.3 g/d (CI, 6.0 to 15.1 g/d; P less than 0.001). The median plasma albumin rose by 14 g/L from 24 to 38 g/L (CI, 11 to 19 g/L; P less than 0.001). The median plasma cholesterol fell by 3.26 mumol/L (140 mg/dL) from 10.45 to 6.52 mumol/L (405 to 252 mg/dL) (CI, 1.42 to 7.16 mumol/L; P = 0.01). One patient who had a relapse 30 months after completing therapy responded to re-treatment with renal function and nephrotic variables returning toward normal. The eleventh patient received cyclophosphamide alone and had a course similar to that of the combined therapy group.
  
  
  CONCLUSIONS
  Cyclophosphamide plus prednisone can promote prolonged remissions in membranous glomerulonephritis even when renal function is already declining.
authors.affiliation: Montefiore University Hospital, Pittsburgh, Pennsylvania.
authors.forename: F J
authors.initials: FJ
authors.lastname: Bruns
authors.forename: S
authors.initials: S
authors.lastname: Adler
authors.forename: D S
authors.initials: DS
authors.lastname: Fraley
authors.forename: D P
authors.initials: DP
authors.lastname: Segel
mesh_terms: D000328:Adult; D000368:Aged; D002784:Cholesterol / Q000097:blood; D003404:Creatinine / Q000097:blood; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D011507:Proteinuria / Q000188:drug therapy; D012074:Remission Induction; D012709:Serum Albumin / Q000187:drug effects; D013997:Time Factors
chemical_list: D012709:Serum Albumin; D003520:Cyclophosphamide; D002784:Cholesterol; D003404:Creatinine; D011241:Prednisone