It is Necessary to use High Doses of Steroids in the Therapy of Membranous Nephropathy?

Abstract

Idiopathic membranous nephropathy (IMN) has a variable course with frequent spontaneous remission, therefore some authors recommend only non-specific therapy. But in the cases with nephrotic syndrome, the risk of kidney failure is greater in the untreated patients than those who are treated. Various therapeutic schemes proposed in recent years have shown favorable results as a famous Ponticelli regimen, but almost all included the use of immunosuppressants. Although used at low doses, immunosuppressants have the risk of causing long-range tumors over the course of many years. The monotherapy with steroids is not recommended in this nephropathy. We have put in place a therapeutic protocol by usingonly methylprednisolone at low doses to see if it was possible to get a remission of nephrotic syndrome, in order to avoide important side effects. We have treated eleven patients with idiopathic adult membranous nephropathy documented so by renal biopsy and nephrotic syndrome. It was observed a complete remission in 7 patients and a partial remission patients. in 3patients. Onlyone patient did not respond. The follow-up was 17.5 months (3-48 months). In 5 patients total remission persisted after 28.8 months on average (12-48 months). In 2 patients with complete remission and 3 with partial remission, a recurrence of nephrotic syndrome occurred after an average of 6.2 months (3-12 months). These results seem interesting, but before drawing any conclusion, it will be necessary to extend the cases and the follow-up procedure.