Nineteen patients with biopsy proven
membranoproliferative glomerulonephritis type I (MPGN I) and a minimum of three years of follow-up (mean 6.5 +/- 0.7 years) have been treated with an uncontrolled regimen of limited
corticosteroids. Initial
therapy ranged from 20 mg per os (po) every other day to 30 mg/kg/day i.v. for three consecutive days, depending on clinical disease severity.
Therapy was then decreased based on each patient's improving clinical status. At diagnosis
creatinine clearance (CCr) was less than 80 ml/min/1.73 m2 in 12 patients and less than 50 in 2. All patients had
hematuria and
proteinuria, with 15 in the nephrotic range.
Hypertension, present at diagnosis in 13, developed in five others following institution of
prednisone, and was controlled medically. Renal biopsy was repeated after two years of
therapy prior to
cessation of treatment (mean total
treatment duration 38 +/- 3 months). Follow-up biopsy revealed decreased glomerular inflammatory activity in 88% of patients. All patients have now been off
prednisone for 40 +/- 9 months. The mean CCr is 126 +/- 5 ml/min/1.73 m2. Eight patients have normal urinalyses. These data suggest that
early therapy with a limited course of
corticosteroids, and control of associated
hypertension, may forestall progressive
renal insufficiency in children with MPGN type I.