Mary Carla Estevez Diz ,Gianna Mastroianni Kirsztajn *
Background: Membranous nephropathy (MN) is one of the most frequent causes of nephrotic syndrome in adults. The clinical course is variable, and its treatment is still a matter of controversies. The aim of this study was to establish when immunosuppressive (IMS) therapy should be indicated in our population with MN.
Methods: We evaluated retrospectively clinical and laboratorial data from 71 patients with primary MN, followed in the Glomerulopathy Section (UNIFESP), from 1976 to 2006.
Results: Ten of the 71 patients have not received any specific IMS treatment, while the remainders were submitted to several specific therapies. The final mean creatinine in the non-treated (2.0 ± 1.83 mg/dL) was higher than that of the treated group (1.66 ± 1.54 mg/dL) and there was a strong and significant difference between decreases of proteinuria levels in the group of treated patients when compared to the non treated group. The highest frequency of complete remission was observed in the treated patients (22.9% vs. 10% in non treated) and the highest index of non response in the non treated group (60% vs. 41% in treated), but these differences were not statistically significant. When we compared the patients who received oral corticosteroid, or intravenous (IV) methylprednisolone (MP) plus cyclophosphamide (Cyp), and non treated patients, we observed a favorable effect of the IMS treatment, especially of IV MP plus Cyp.
Conclusions: In a long term follow-up of MN patients IMS treatment was associated to better renal outcome, including more frequent remission, lower final proteinuria and serum creatinine.
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