STEROIDS AND CHLORAMBUCIL TREATMENT IN ME MBRANOUS GLOMERULONEPHRITISWITH PROGRESSIVE RENAL-INSUFFICIENCY

Although many cases of membranous glomerulonephritis undergo spontaneo us remission, the appearance of renal insufficiency implies a very bad prognosis. We report the evolution of four patients with membranous g lomerulonephritis and progressive renal insufficiency treated with ora l prednisone and chlorambucil for six months. All of then had nephroti c syndrome with proteinuria of 14.2 +/- 4 g/24 h and serum creatinine (SCr) of 2.2 +/- 0.5 mg/dl. After of then treatment, renal function ha d normalized in 3 patients and improved in the remaining one. Regardin g proteinuria, two cases showed a complete remission, one patient a pa rtial remission and the remaining had persistent nephrotic-range prote inuria; although with a reduction greater than 50% of the basal value and a normalization of serum albumin. The beneficial effects were appa rent after the second-third month of treatment. Follow-up after the en d of treatment was 20,2 +/- 7,5 months; no other derangements in renal function were observed. Last SCr was 1,3 +/- 0,3 mg/dl with proteinur ia of 2,1 +/- 2,7 g/24 h. In conclusion, steroid plus chlorambucil tre atment can prevent the evolution towards advanced renal insufficiency in membranous glomerulonephritis with nephrotic syndrome and progressi ve renal insufficiency.