It has been claimed that long-term
prednisone treatment ameliorates the course of children with
mesangiocapillary glomerulonephritis (MCGN). The International Study of
Kidney Disease in Children conducted a randomized, double-blinded, placebo-controlled clinical trial in 80 children with idiopathic MCGN, including 42 patients with type I disease, 14 with type II disease, 17 with type III disease, and 7 with nontypable disease. Criteria for admission included heavy
proteinuria and a glomerular filtration rate of greater than or equal to 70 ml/min per 1.73 m2.
Prednisone or
lactose, 40 mg/m2, was given every other day as a single morning dose. The mean
duration of treatment was 41 months,
renal failure being the most common reason for termination of
therapy. Treatment failure was defined as an increase from baseline of 30% or more in serum
creatinine, or more than 35 mumol/l. Overall, treatment failure occurred in 55% of patients treated with
lactose, compared with 40% in the
prednisone group. Life-table analysis showed a renal survival rate (i.e., stable renal function)
at 130 months of 61% among patients receiving
prednisone and 12% among patients receiving
lactose (P = 0.07). Of patients with type I or III MCGN, 33% treated with
prednisone were treatment failures, compared with 58% in the
lactose group. Long-term treatment with
prednisone appears to improve the outcome of children with MCGN.