R. Brunkhorst et al., LOW-DOSE PREDNISOLONE CHLORAMBUCIL THERAPY IN PATIENTS WITH SEVERE MEMBRANOUS GLOMERULONEPHRITIS, The Clinical investigator, 72(4), 1994, pp. 277-282
Because of the high rate of spontaneous remission, treatment of membra
nous nephropathy with prednisolone and chlorambucil is still controver
sial. The aim of this study was to give this therapy only to those pat
ients at risk of developing renal insufficiency and to test the effica
cy of a low-dose therapeutic regimen. Seventeen patients with more tha
n 10 g protein excretion per day (mean 16.9) and/or a deterioration in
renal function (mean serum creatinine, 162 mumol/l) were included. Se
rum total protein, serum lipids, proteinuria, serum creatinine, and bl
ood pressure were measured, along with the diuretic and antihypertensi
ve medication. The observation time before the start of treatment was
27 +/- 27 months. Steroids were given during months 1, 3, and 5 (methy
lprednisolone 3 x 500 mg intravenously) prednisolone 0.5 mg/kgBW daily
per os for 1 week, then tapered by 0.1 mg/kg BW/week for 1 month). Ch
lorambucil was given during months 2, 4, and 6 at a dose of 0.12 mg/kg
BW daily. At the end of treatment proteinuria had significantly decrea
sed (mean of all patients, 7.8 +/- 1.4 g/d) in all patients. Six month
s after the end of treatment proteinuria was significantly lower than
at baseline in 14 of 17 patients. Hypoproteinemia and hyperlipidemia h
ad improved; diuretic and antihypertensive medication were reduced. El
evated serum creatinine decreased in 7 of 9 patients (pretreatment, 22
7 +/- 39 mumol/l; 6 months, 176 +/- 28 mumol/l). Nonresponders with re
spect to serum creatinine responded with respect to proteinuria. Regar
ding adverse effects, two patients complained of dyspepsia while takin
g steroids; during chlorambucil treatment two patients experienced nau
sea and lack of appetite, and one developed leukopenia (1600/mul). Chl
orambucil was stopped and cell counts normalized 2 weeks later. We con
clude that low-dose prednisolone/chlorambucil is both safe and efficie
nt in the majority of patients with severe membranous nephropathy.