RESPONSE OF TYPE-I MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS TO PULSE METHYLPREDNISOLONE AND ALTERNATE-DAY PREDNISONE THERAPY

Sixteen children with biopsy-confirmed type I membranoproliferative gl omerulonephritis (MPGN) were treated with six alternate-day intravenou s pulses of methylprednisolone followed by single-dose alternate-day p rednisone for 12-66 months (mean 37 months). The average length of fol low-up was 52 months (range 12-127 months). Compared with pretreatment values, the frequency of hematuria (13/16 vs. 8/16, P<0.05) and the l evels of serum albumin (2.66 +/- 0.69 vs. 3.76 +/- 0.39 g/dl, P<0.001) , creatinine clearance (97 +/- 37 vs. 129 +/- 26 ml/min/1.73 m(2), P<0 .001), and proteinuria (5.2 +/- 5.1 vs. 1.0 +/- 0.8 g/day, P<0.001) we re significantly improved after 3 months of therapy. Improvement has p ersisted through the end of the follow-up period. Repeat kidney biopsi es showed a significant reduction in acute changes but an increase in chronic changes. Thirteen patients have been off therapy from 1 to 74 months (mean 20.8 months). Nine have a normal urinalysis, creatinine c learance, and protein excretion. The remainder have normal renal funct ion but proteinuria ranging from 3.2 to 4.3 g/day. The data support th e evidence of other investigators that corticosteroid therapy is benef icial in type I MPGN and suggest that initiation with pulse methylpred nisolone may promote early stabilization of the disease.