IMMUNOSUPPRESSIVE TREATMENT OF THE NEPHROTIC SYNDROME DUE TO MESANGIAL LESIONS

To assess the effectiveness of an intensive immunosuppressive regimen on the nephrotic syndrome due to mixed membranous and mesangial lesion s, we studied 18 patients with nephrotic syndrome and miscellaneous hi stologic features characterized by mesangial proliferation and scleros is, non-specific basement membrane changes such as thickening, fraying and scalloping, in the absence of extensive immune complex deposition by immunofluorescence. The patients were treated with an immunosuppre ssive regimen that combined prednisone and cyclophosphamide for at lea st 6 months with the following schedule: 1) induction with prednisone daily 250 to 750 mg i.v. for 3 to 8 days, plus cyclophosphamide 100 to 200 mg p. o. daily; 2) maintenance with prednisone 100 to 200 mg p. o . in alternate days for 30 to 75 days, and cyclophosphamide as before; 3) tapering, with prednisone in alternate day regimen, reduced on ave rage by 25 mg every month, plus cyclophosphamide as before; 4) discont inuation of cyclophosphamide and slow withdrawal of prednisone. Treatm ent lasted on average 9 months, with an average cumulative dose of pre dnisone of 9.2 g and of cyclophosphamide of 26.7 g. At the end of trea tment, 14 patients had a complete remission and 4 remained stable. On longer follow-up, one out of these 4 patients, who had renal failure b efore treatment, subsequently progressed to end-stage renal disease. N ine patients relapsed after an average remission of 6 years. Eight of them remitted completely on a repeat cycle. One patient refused the re treatment and progressed to end-stage renal disease within one year. A fter an average follow-up of 7.3+/-1.1 years, plasma creatinine for th e whole group had fallen from 138+/-26 to 103+/-20 mu mol/l and protei nuria from 6.7+/-0.7 to 0.4+/-0.2 g/d (p <0.001). In conclusion, in pa tients with these forms of nephrotic syndrome this immunosuppressive r egimen is highly effective in inducing remission, in preventing progre ssion to end-stage renal disease and in treating relapses.