Relapsing membranous nephropathy - Response to therapy of relapses compared to that of the original disease

Background: Although controversial, treatment of membranous nephropathy app ears to yield a reduction in the degree of proteinuria and conservation of renal function. Methods: We report herein our experience with the treatment with steroids alone (group II, n = 13), or in combination with immunosuppr essants (group III, n = 19) of patients with membranous nephropathy and the nephrotic syndrome, with a mean follow-up of 8.37 years. Results: All pati ents underwent a first remission, with 24-hour urine protein excretion fall ing to 0.63 +/- 0.25 g in group II and 0.62 +/- 0.26 g in group III (p = NS ) after 12.69 +/- 10.94 months of treatment in group II and 18.95 +/- 13.17 months in group III (p = NS). Three patients from group II (23%) and seven patients from group III (36.8%) experienced four and eight relapses, respe ctively (proteinuria in 24 h 4.0 +/- 0.80 g in group II relapsers and 4.4 /- 0.87 in group III relapsers; p = NS). On treatment, all relapses remitte d (second remission) after 7 +/- 6.93 months of therapy for group II and 8. 6 +/- 6.70 months of treatment for group III (p = NS). Thereafter, no patie nts from group II, but 3 patients from group III (33.3%) had a second relap se. After treatment, all relapses remitted (third remission) in 3.3 +/- 1.5 3 months of therapy. Conclusions: These studies show that relapses, which o ccur in one-third of patients, respond favorably to treatment albeit remitt ing in approximately half the time, and that the duration of remission gets progressively longer in the later compared to the earlier remission.