Primary glomerulonephritides with nephrotic syndrome. Limitations of therapy in adult patients

Thirty years of clinical studies have shown that a correct therapeutic appr oach to human glomerulonephritides with nephrotic syndrome requests the eva luation of three important parameters such as renal biopsy, long monitoring of daily proteinuria and renal function, In addition, age and clinical man ifestations should be considered. Corticosteroids, alkylating agents (cyclo phosphamide, chlorambucil) and purine analogues are currently used in the t reatment of primary glomerulonephritis: (minimal-change disease (MCD), foca l segmental glomerulosclerosis (FSGS), membranous (MGN) and membranoprolife rative glomerulonephritis (MPGN)), however results are different. Patients with nephrotic syndrome in MCD when treated with corticosteroids and/or cyt otoxic drugs have complete or partial remission in a more than 90% of cases , On the contrary, nephrotic FSGS remits completely or partially only in 50 % of treated cases when a more aggressive and prolonged immunosuppressive t herapy is carried out. Data from clinical trials in MGN patients are contro versial, however it is evident that a greater percentage of patients with s tage 1 and stage 2 renal lesions benefit from corticosteroids in associatio n with immunosuppressive drugs. Finally, no encouraging data have been obta ined by clinically controlled trials in patients with MPGN, Future perspect ives suggest the use of other drugs such as receptor blockade of cytokines and growth factors, administration of cytokine antagonists, intracellular s ignalling blockade and gene therapy with antisense oligonucleotides. Unfort unately, until specific therapies become available, we have to use unspecif ic or only symptomatic therapy.