Clinical courses of the adult patients with idiopathic membranous nephropathy / 대한내과학회지

ABSTRACT

BACKGROUND: Idiopathic membranous nephropathy (IMN) causes variable clinical courses, such as from asymptomatic urinary abnormalities, nephrotic syndrome to end-stage renal failure. We evaluated clinical findings and effects of steroid and steroid with chlorambucil in patients with IMN. METHODS: We reviewed 37 cases of biopsy-proven patents of IMN whose follow-up duration was at least 2 years, retrospectively. The mean follow-up duration of the cases was 74 +/- 49 months. In the cases of steroid therpy, prednisolone 40, 50 or 60 mg/day was given for maximal 16 weeks. Steroid-chlorambucil treatment was done for the cases of no response or relapse after steroid therapy, severe nephrotic syndrome or elevated serum creatinine more than 1.2 mg/dL. We did 3 cycles of treatment. Every cycle was consisted of intravenous 1 gram of methylprednisolone for 3 days followed by prednisolone 0.5 mg/kg/day orally for 27 days then chlorambucil 0.2 mg/kg/day for 28 days. Therapeutic results were evaluated. RESULTS: The mean age was 41 +/- 15 years and 5-6th decade was 48.6%. Male to female ratio was 1.3 1. Nephrotic syndrome was in 86.5% in the cases. The results of prednisolone therapy was done in 25 cases were 20% of complete remission (CR), 28% of patial remission (PR) and 52% of no respone (NR). There was no difference between the response rate and dosage of prednisolone. Steroid-chlorambucil therapy was done in 18 cases totally, 5 cases in the first treatment and 13 cases of no response or relapsed cases after prednisolone treatment. The results were 22.2% of CR, 50% of PR and 27.8% of NR. This results were no difference between steroid and chlorambucil combined therapy. Spontaneous remission was observed 35.1% of the total cases, 21.6% of spontaneous CR and 13.5% of spontaneous PR after the final observations. The final results were 16.2% of CR and 10.8% of PR after prednisolone or chlorambucil combined therapy. Progressive renal disease were developed in 6 cases (16.2%) and the mean renal surval time measured by projected reciprocal creatinine from diagnosis to the point of 0.1 was 129 +/- 79 months. CONCLUSION: Nephrotic syndrome was presented in 86.5% of cases and with high remission rates such as 37.8% of complete and 24.3% of partial remission in IMN. Progressive renal failure was occurred in 16.2% of cases and most of the cases progressed very slowly. There was no different results between steroid alone and chlorambucil combined therapy.