title: 20 years after methylprednisolone/chlorambucil treatment in idiopathic membranous nephropathy stage II-III with nephrotic syndrome.
abstract: There is now controlled evidence that a 6-month course with methylprednisolone and chlorambucil may favour remission of the nephrotic syndrome and may significantly improve the 10-year kidney survival in patients with idiopathic membranous nephropathy. We analyzed the outcome of 15 nephrotic patients (proteinuria 7.06 +/- 1.07 g/d), stage II-III membranous nephropathy, aged 37.93 +/- 2.32, 8 males and 7 females, with normal serum creatinine (62.8 +/- 2.34 micromol/l), followed > 10 years after the treatment. It consisted of 1g i.v. methylprednisolone for three consecutive days, followed by oral steroids 0.4 mg/kg/d and chlorambucil 0.2 mg/kg/d monthly, alternatively. 10 patients, age and sex matched, who refused any treatment of any reason, represented the control group. Complete remission was defined as protein loss of 0.2 g/d, partial 0.2-2 g/d with normal creatinine and renal dysfunction as increase in plasma creatinine. The follow-up period was between 10 and 20 years. Complete remission after the treatment was noted in 9/15, partial in 4/15, and 2/15 patients did not respond. 10-year survival rate of the whole group was 100%, 15-year - 86.7%, i.e. two patients with persistent nephrotic syndrome developed end-stage renal failure after 12 years. 13/15 patients (complete, partial remission) were followed > 15 years without development of end-stage renal failure. One patient (female, 32) developed idiopathic thrombocytopenia after 8 years. 3 patients (complete remission) were followed > 20 years, they are still without proteinuria. 10-year survival rate of untreated patients was 40%. It is concluded that in nephrotic patients with stage II-III membranous nephropathy steroids/chlorambucil therapy may be effective in favoring remission and in preserving renal function.
authors.affiliation: Macedonian Academy of Sciences and Arts, R. Macedonia. maknefpo@mt.net.mk
authors.forename: M
authors.initials: M
authors.lastname: Polenakovic
authors.forename: L
authors.initials: L
authors.lastname: Grcevska
authors.forename: S
authors.initials: S
authors.lastname: Dzikova
mesh_terms: D000328:Adult; D002699:Chlorambucil / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D015433:Glomerulonephritis, Membranous / Q000150:complications / Q000188:drug therapy*; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D009404:Nephrotic Syndrome / Q000209:etiology*; D012074:Remission Induction
chemical_list: D005938:Glucocorticoids; D002699:Chlorambucil; D008775:Methylprednisolone