A Study of Treatment in Adult Patients with Idiopathic Membranous glomerulonephritis

Bae, Sung Jin; An, Won Suk; Park, Geun Wook; Park, Hee Seung; Kim, Gu; Kim, Dong Su; Kim, Kwang Dong; Jung, Jae Youl; Chang, Kwang Yul; Kim, Sun Tack; Kim, Seong Eun; Kim, Ki Hyun

Abstract

OBJECTIVE
We aimed to compare efficacy of treatment between steroid therapy and steroid-chlorambucil combination therapy in patients with adult-onset idiopathic membranous glomerulonephritis (MN).
METHODS
A series of 31 biopsy-proved idiopathic MN patients was analyzed retrospectively to estimate effect of treatment with steroid and/or cytotoxic agent. All patients (male 15, female 16, mean age of 37 years old) presented a full-blown nephrotic syndrome (proteinuria >3.0gm/day, serum albumin <3.0mg/dL, edema) at the initiation of treatment and were observed for at least 6 months (mean follow up period: 28 +/- 23 months). Clinical and laboratory information were obtained at the time of presentation and at last follow up. Each patient was assigned to one of the following protacols. 1) Steroid therapy prednisolone 40 or 60mg/day (single dose) for 16 weeks. 2) Steroid-Chlorambucil combination therapy: for 6 months with three cycles of methylprednisolone pulse therapy (lgm 1V for 3 days), prednisolone 0.5mg/kg/day for 27 days, then chlorambucil 0.2mg/kg/day for 28 days. 3. Cyclophosphamide 2mg/kg/day for 28 days.
RESULTS
1) Final status in total 31 cases irrespective of therapeutic modality were complete remission in 5 (16%) cases, partial remission in 9 (29%) cases, no response in 12 (41%) cases, spontaneous complete remission in 1 cases, and spontaneous partial remission in 1 case. 2) After initial steroid therapy (in 25 cases), We observed no response in 17 (68%) case, partial remission in 3 (12%) cases, complete remission in 3 (12%) cases, and spontaneous partial remission in 2 (8%) cases. 3) The combination therapy (steroid and chlorambucil) tried in 10 cases results in 5 (50%) cases of partial remission, 2 (20%) cases of complete remission, 1 (10%) case of spontaneous partial remission, and 2 (20%) cases of no response. 4) During follow up period, renal functional deterioration was absent in any case and final albumin levels were significantly increased (p<0.05).
CONCLUSION
Steroid-chlorambucil combination protocol is considered to be a more effective treatment with higher rate of overall remission compared to steroid therapy. Idiopathic MN itself seems to have a relatively benign course when considering that renal function was preserved in all cases without progression to chronic renal failure and that a few cases of spontaneous remission could be observed. For the limitation in number of cases and duration of follow up in this study, it needs prospective controlled study of more larger scale with long-term follow up to get a more reliable results.