A REVIEW OF THERAPEUTIC STUDIES OF IDIOPATHIC MEMBRANOUS GLOMERULOPATHY

The treatment of idiopathic membranous glomerulopathy remains an enigm a. We have reviewed many of the important clinical trials concerning m embranous glomerulopathy using a meta-analysis and a secondary pooled analysis to test the effects of corticosteroid or alkylating therapy c ompared with no treatment on renal survival and complete remission of the nephrotic syndrome, A search was performed using MEDLINE (1968 thr ough 1993) for articles on idiopathic membranous glomerulopathy and gl omerulonephritis. Bibliographies of articles were reviewed for complet eness. Sixty-nine articles were reviewed. Meta-analysis was performed for four trials that evaluated corticosteroids compared with no treatm ent and for three trials that evaluated alkylating therapy compared wi th no treatment, Pooled analysis was performed on randomized and prosp ective studies (10 studies) and then with 22 case series added. All st udies evaluated renal biopsy-proven disease. Meta-analysis was perform ed on the relative chance of being in complete remission for each stud y. Renal survival could be evaluated by pooled analysis only. For pool ed analyses, Cox's proportional hazard and logistic regression models were used to test the effect of therapy on renal survival and the neph rotic syndrome, respectively. Data concerning gender, nephrotic syndro me, and geographic region were used in all statistical models. Evaluat ion of renal survival revealed no differences by treatment group (P > 0.1). By meta-analysis, the relative chance of complete remission was not improved for corticosteroid-treated patients (1.55; 95% confidence interval, 0.99 to 2.44; P > 0.1), but was improved for patients treat ed with alkylating agents (4.8; 95% confidence interval, 1.44 to 15.96 ; P < 0.05) when compared with no treatment. Pooled analysis of random ized and prospective studies, as well pooled analysis with all studies , supported the findings of the meta-analysis. Corticosteroids or alky lating therapy did not improve renal survival in idiopathic membranous glomerulopathy. Complete remission of the nephrotic syndrome was obse rved more frequently with the use of alkylating agents. (C) 1995 by th e National Kidney Foundation, Inc.