Because of the high rate of spontaneous remission, treatment of
membranous nephropathy with
prednisolone and
chlorambucil is still controversial. The aim of this study was to give this
therapy only to those patients at risk of developing
renal insufficiency and to test the efficacy of a low-dose therapeutic regimen. Seventeen patients with more than 10
g protein excretion per day (mean 16.9) and/or a deterioration in renal function (mean serum
creatinine, 162 mumol/l) were included. Serum total
protein, serum lipids,
proteinuria, serum
creatinine, and blood pressure were measured, along with the
diuretic and
antihypertensive medication. The observation time before the start of treatment was 27 +/- 27 months.
Steroids were given during months 1, 3, and 5 (
methylprednisolone 3 x 500 mg intravenously)
prednisolone 0.5 mg/kgBW daily per os for 1 week, then tapered by 0.1 mg/kg BW/week for 1 month).
Chlorambucil was given during months 2, 4, and 6 at a dose of 0.12 mg/kgBW daily. At the end of treatment
proteinuria had significantly decreased (mean of all patients, 7.8 +/- 1.4 g/d) in all patients. Six months after the end of treatment
proteinuria was significantly lower than at baseline in 14 of 17 patients.
Hypoproteinemia and
hyperlipidemia had improved;
diuretic and
antihypertensive medication were reduced. Elevated serum
creatinine decreased in 7 of 9 patients (pretreatment, 227 +/- 39 mumol/l; 6 months, 176 +/- 28 mumol/l). Nonresponders with respect to serum
creatinine responded with respect to
proteinuria. Regarding adverse effects, two patients complained of
dyspepsia while taking
steroids; during
chlorambucil treatment two patients experienced
nausea and lack of appetite, and one developed
leukopenia (1600/microliters).(ABSTRACT TRUNCATED AT 250 WORDS)