Glomerulonephritis (GN) accounts for 10%-20% of the total incident cases of
end stage renal disease (
ESRD), and is the third most common cause of
ESRD after diabetes and
hypertension in western countries. The pathogenesis of
glomerulonephritis is prevalently immune mediated: humoral and cell-mediated immunity are involved, although the rationale for an etiological treatment is still lacking. In the last forty years, empirical treatment based upon the use of
corticosteroids and/or immunosuppressive drugs have obtained excellent results in improving survival of both the patient and the kidney. Almost 95% of children affected by
minimal change disease (MCD) achieve remission of
proteinuria within 4 to 8weeks of
prednisone administration. In adults with
focal segmental glomerulosclerosis (FSGS),
prednisone induces complete or partial remission in the majority of patients, but a longer period of
steroid treatment or the combination of
calcineurin inhibitors or cytotoxic drugs can be needed. A percentage of 65%-70% of patients with
idiopathic membranous nephropathy (MN) reach complete or partial remission with a 6-month course of
therapy alternating
glucocorticoids with
alkylating agents.
Glucocorticoids plus
cyclophosphamide, and, on occasion,
plasmapheresis are effective in 70%-90% of patients with
ANCA-associated vasculitis (AAV). Fifty percent of responders relapse within the 3-5years and currently, the mortality of AAV at 1year exceeds 15%. This article is aimed to analyze the risk-to-benefit balance of
steroids and conventional immunosuppressive regimens, focusing, for a sake of brevity, on idiopathic
nephrotic syndrome (INS) and
ANCA associated vasculitis.