A 10-YEAR FOLLOW-UP OF A RANDOMIZED STUDY WITH METHYLPREDNISOLONE ANDCHLORAMBUCIL IN MEMBRANOUS NEPHROPATHY

The natural course of idiopathic membranous nephropathy is variable, w ith some patients slowly progressing to renal failure while others mai ntain normal renal function over the entire time. Whether to treat thi s disease or not is controversial due to the lack of controlled data a bout the long-term effects of treatment. We updated at 10 years the re sults of a controlled trial in which 81 patients with idiopathic membr anous nephropathy and nephrotic syndrome were randomly assigned to rec eive symptomatic therapy (39 patients) or a treatment of six months wi th methylprednisolone and chlorambucil (42 patients). The probability of surviving without developing end-stage renal disease at 10 years wa s 92% in patients given methylprednisolone and chlorambucil versus 60% in controls (P = 0.0038). The slope of the reciprocal of plasma creat inine up to 10 years was significantly better in treated patients than in controls (P = 0.035). The probability of having a complete or part ial remission of the nephrotic syndrome was significantly higher in tr eated patients (P = 0.000). Patients assigned to therapy spent signifi cantly longer time without nephrotic syndrome than untreated patients (P = 0.0001). Four patients had to stop treatment because of reversibl e side-effects. In the long-term one treated patient developed diabete s and another one became obese. In conclusion, a six-month therapy wit h methylprednisolone and chlorambucil increases the probability of rem ission of proteinuria and protects from renal function deterioration e ven in the long-term. This treatment may avoid dialysis or death withi n 10 years to about one third of nephrotic patients with membranous ne phropathy.