In this study, we retrospectively analyzed the effects of treatment in 19 patients with membranous
lupus nephritis (MLN) and
nephrotic syndrome. Eight patients were treated with
corticosteroids alone, and the other 11 patients received
methylprednisolone and
chlorambucil alternated every other month for 6 months. At presentation, sex, age, duration of renal disease before renal biopsy, plasma
creatinine, and arterial
hypertension were similar in the two study groups. Of the eight patients treated with
corticosteroids alone, three showed complete remission and one partial remission of the
nephrotic syndrome. During the follow-up (mean, 114+/-63 months), seven of these eight patients developed one or more renal flare-ups. Of the 11 patients treated with
methylprednisolone and
chlorambucil, seven had complete remission, and the other four had partial remission of the
nephrotic syndrome. During the follow-up (mean, 83+/-59 months), only one patient had renal flare-up. At the end of the follow-up, all patients were alive, but three patients in the group treated with
corticosteroids alone had developed a doubling of plasma
creatinine, and another patient had persistent
nephrotic syndrome. Two other patients were
in complete remission, one patient was in partial remission, and the last patient had nonnephrotic
proteinuria. In the group of patients treated with
methylprednisolone and
chlorambucil, one patient developed extracapillary
glomerulonephritis and eventually entered
end-stage renal failure 24 years after the clinical onset of renal disease. Seven patients were
in complete remission, and three patients were in partial remission at the last follow-up visit. This retrospective study suggests that
methylprednisolone and
chlorambucil may induce a more stable remission of
nephrotic syndrome and may better protect renal function in the long term in comparison with
corticosteroids alone. However, these results must be confirmed by a prospective controlled trial.