PROGNOSTIC FACTORS IN IDIOPATHIC MEMBRANOUS NEPHROPATHY

Membranous nephropathy is the most frequent cause of glomerulonephriti s in adults with nephrotic syndrome, Approximately one quarter of the patients develop end-stage renal disease, Another quarter enters compl ete remission during follow-up, Treating all patients with membranous nephropathy with immunosuppressive drugs would unnecessarily expose at least one quarter of the patients to these toxic drugs, Identifying p atients at highest risk would allow tailor-made treatment, Many risk f actors have been found, such as male sex, HLA type DR3+/B8+, white rac e, advanced age, and tubulointerstitial changes or focal sclerosis fou nd with renal biopsy, In addition, nephrotic syndrome, elevation of im munoglobulin G excretion or beta(2)-microglobulin excretion, low serum albumin, high serum cholesterol, an elevation of urinary excretion of complement activation products, impaired renal function at diagnosis, and, finally, hypertension are associated with a higher risk of renal function deterioration during follow-up, We have critically reviewed the literature and summarized the clinical significance of the above-m entioned risk factors in predicting subsequent renal function deterior ation in patients with membranous nephropathy. (C) 1998 by the Nationa l Kidney Foundation, Inc.