Spontaneous remission is a well known characteristic of idiopathic membranous nephropathy, but contemporary studies describing predictors of remission and long-term outcomes are lacking. We conducted a retrospective, multicenter cohort study of 328 patients with nephrotic syndrome resulting from idiopathic membranous nephropathy that initially received conservative therapy. Spontaneous remission occurred in 104 (32%) patients: proteinuria progressively declined after diagnosis until remission of disease at 14.7 Ϯ 11.4 months. Although spontaneous remission was more frequent with lower levels of baseline proteinuria, it also frequently occurred in patients with massive proteinuria: 26% among those with baseline proteinuria 8 to 12 g/24 h and 22% among those with proteinuria Ͼ12 g/24 h. Baseline serum creatinine and proteinuria, treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists, and a Ͼ50% decline of proteinuria from baseline during the first year of follow-up were significant independent predictors for spontaneous remission. Only six patients (5.7%) experienced a relapse of nephrotic syndrome. The incidence of death and ESRD were significantly lower among patients with spontaneous remission. In conclusion, spontaneous remission is common among patients with nephrotic syndrome resulting from membranous nephropathy and carries a favorable long-term outcome with a low incidence of relapse. A decrease in proteinuria Ͼ50% from baseline during the first year predicts spontaneous remission.

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Acquired renal cystic disease is an entity which is characterized by the progressive substitution of the atrophic renal parenchyma by multiple cysts in patients with renal insufficiency. Its main complications are hemorrhage and tumorous degeneration. The case discussed is a 57-year-old patient with terminal renal insufficiency secondary to interstitial nephropathy, who, following 6 years of treatment with hemodialysis and renal transplantation, developed a state of persistent hematuria requiring nephrectomy of the left kidney. Histological study revealed multiple cysts of monostratified epithelium with intracavitary projections, multiform adenomas and multifocal malignant tumorous polymorphism. The patient died in a state of progressive cachexia with pleural and hepatic metastasis.

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