We conducted a prospective randomized study in which patients with biopsy-confirmed
idiopathic membranous nephropathy were assigned to receive either a six-month course of
prednisone given on alternate days (45 mg per square meter of body-surface area; n = 81) or no specific treatment (n = 77). The mean duration of follow-up was 48 months. Patients in the
prednisone group (median age, 46 years) entered with a mean disease duration of 15 months, a median
creatinine clearance of 1.2 ml per second per 1.73 m2 (range, 0.25 to 2.6), and a median rate of urinary
protein excretion of 6.8 g per day (0.3 to 26). The annual change in the corrected
creatinine clearance at six months did not differ between the
prednisone group and the control group (0.10 vs. 0.06 ml per second; P = 0.8), or at the last follow-up evaluation (-0.07 vs. -0.02 ml per second; P = 0.2; 95 percent confidence interval on the difference, -0.03 to 0.13). The proportion of patients with complete remission of
proteinuria was also similar in the groups at 6 and 12 months and after a mean of 48 months. Outcomes were similar in the two groups with respect to progression to
renal failure (3 vs. 4 patients), death (3 vs. 1 patient), complete remission of
proteinuria at 36 months (16 vs. 19 patients), and a decline of 25 percent or more in the
creatinine clearance at 60 months (32 vs. 25 percent of patients). A multivariate analysis, which adjusted for differences at entry in sex distribution, urinary
protein excretion, and
creatinine concentration, as well as other prognostic variables, failed to provide an explanation for the lack of effect of
prednisone. We conclude that a six-month course of
therapy in which
prednisone is given on alternate days is of no benefit to patients with
idiopathic membranous nephropathy.