NON-NEPHROTIC CHILDREN WITH MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS - ARE STEROIDS INDICATED

Alternate-day steroids are currently recommended to treat children wit h membranoproliferative glomerulonephritis (MPGN). This recommendation is based largely on uncontrolled studies demonstrating improved renal survival with steroid therapy. We reviewed the outcome of 39 children who presented with MPGN between 1968 and 1990; 27 children were treat ed with steroids and 12 children received no drug therapy. Life-table analysis comparing renal survival of treated versus untreated children demonstrated no difference by log rank analysis. Treated and untreate d groups were compared on the basis of nine features at presentation: age, sex, type of MPGN, presence and type of hematuria, hypocomplement emia, renal insufficiency, hypertension, and nephrosis. Treated childr en were likely to be female (P<0.01) and nephrotic (P<0.02). Actuarial survival analyses were performed comparing the nine features with ren al survival through 10 years of follow-up. Normotensive (P<0.025) and non-nephrotic (P<0.05) children had improved renal survival. The 11 no n-nephrotic children demonstrated 100% long-term renal survival, inclu ding 7 who received no steroid therapy. At last follow-up, all non-nep hrotic children had normal renal function, serum albumin levels >3 g/d l, and were normotensive. These data suggest that non-nephrotic childr en with MPGN may forego steroid treatment without compromising long-te rm renal function. The current common practice of treating all childre n with MPGN with steroids should be re-examined.