PROGRESSIVE VERSUS INDOLENT IDIOPATHIC MEMBRANOUS GLOMERULONEPHRITIS

There is still controversy about safe and effective therapy for idiopa thic membranous glomerulonephritis (MGN). Over 20 years, we have simpl y observed our patients clinically after diagnosis, and only used aggr essive therapy with steroids in high dosage and azathioprine for 21 pa tients with progressive renal failure. The other 42 were thus classifi ed as 'indolent' MGN. Those with 'progressive' MGN had heavier protein uria and worse renal function on presentation, but the overlap was con siderable. Patients with progressive MGN were treated after 1-4 years. All responded promptly, and 5 years after presentation ail were alive , and only one was on dialysis. By 10 years, most were still alive, an d of these most were off dialysis. In five patients, dialysis was dela yed by several years. There were two deaths on dialysis, and three oth er deaths, mostly in older patients. All but one patient with indolent MGN remained stable on symptomatic treatment only, for at least 5 yea rs after presentation. In many, proteinuria fell to insignificant leve ls over 4 years. In these remitting patients, there was a prevalence o f thyroid disease (7), rheumatoid disease (3) and nephrotic presentati on in pregnancy (4). After 6-10 years three patients developed worseni ng proteinuria and renal failure. Five older patients died from unrela ted causes.