Patients with
membranous glomerulonephritis (MGN), impaired renal function and the
nephrotic syndrome are at high risk of developing
renal failure. Twenty-six such patients were studied with serum
creatinine concentrations exceeding 135 microM, and 24-hour urine
protein excretion of at least 3.5 g/day to determine the potential benefit of
cyclophosphamide therapy.
Cyclophosphamide (mean 1.5 mg/kg/day) was given to nine patients for 23 +/- 4 months. These patients were compared with 17 concurrent controls. The two groups did not differ in clinical or laboratory features at the time of biopsy or start of treatment or its equivalent. Six of the nine
cyclophosphamide treated patients and 15 of the 17 controls had received
prednisone therapy. The total follow-up was 49 +/- 10 months in the treated group and 50 +/- 6 months in the controls. At last observation, serum
creatinine values exceeded 400 microM in eight controls (4 on dialysis) and in none of the treated patients. The mean serum
creatinine level was significantly lower (P less than 0.02) in the treated group (173 +/- 24 microM) than in controls (433 +/- 71 0.02) in the treated group (173 +/- 24 microM) than in controls (433 +/- 71 microM). The mean
serum albumin level and 24-hour urine
protein excretion both improved significantly with treatment as compared with controls. There were four complete remissions, five partial remissions and no patient with persistent
nephrotic syndrome after treatment. In the controls, there were no complete remissions, six partial remissions and 11 patients had persistent
nephrotic syndrome (P less than 0.001). Thus,
cyclophosphamide therapy appears to be of benefit in patients with MGN, the
nephrotic syndrome and impaired renal function.