Controlled Trial of Methylprednisolone and Chlorambucil in Idiopathic Membranous Nephropathy

Abstract

Sixty-seven adults with idiopathic membranous nephropathy and the nephrotic syndrome were randomly assigned to symptomatic treatment only or to a six-month course of methylprednisolone alternated with chlorambucil every other month. Patients were followed for one to seven years. At the end of follow-up (mean of 31.4 +/- 18.2 months for the treated group and 37.0 +/- 22.0 for the control group) 23 of 32 treated patients were in complete or partial remission, as compared with 9 of 30 control patients (P = 0.001). Twelve of the treated patients were in complete remission, as compared with only two of the controls. In the treated group there were no changes in renal function during follow-up, whereas in the control group the reciprocal of the plasma creatinin level, which is proportional to the creatinine clearance, decreased significantly (P = 0.00017) after two years of follow-up. Side effects were minimal in all treated patients except two, who were dropped from the study because of peptic ulcer and gastric intolerance to chlorambucil. We conclude that steroid and chlorambucil treatment for six months favors remission of the nephrotic syndrome in adults with idiopathic membranous nephropathy and can preserve renal function for at least some years.

Prophylactic Anticoagulation in Nephrotic Syndrome

“…A survey of all such trials reported between 1979 and 2001 revealed an extraordinarily low rate of thromboembolism (one case in Ͼ500 randomly assigned patients who were followed for Ͼ2000 patient-years). [23][24][25][26][27][28][29] Subtle selection forces operating at the enrollment level may have contributed to this finding. Natural history studies of untreated patients have also noted a low prevalence of thromboembolism in membranous nephropathy.…”

“…A possible argument against "routine" prophylactic anticoagulants in idiopathic membranous nephropathy is that none of the randomized therapeutic trials in membranous nephropathy reported between 1979 and 2001 required that enrolled patients be routinely treated with prophylactic anticoagulants. [23][24][25][26][27][28][29] Because ethical considerations demand that participants in such trials receive standard of care, one would have to conclude that prophylactic anticoagulation of patients with membranous nephropathy (and by inference other patients with nephrotic syndrome) has not yet reached a uniform level of standard of care.…”

Have We Changed the Outcome in Membranous Nephropathy? A Propensity Study on the Role of Immunosuppressive Therapy

“…The immunosuppressive recommendations for MGN based on RCTs include cyclophosphamide, chlorambucil, and cyclosporine regimens (5,18,(33)(34)(35). Most of these, but not all, concomitantly used corticosteroids.…”

Active Focal Segmental Glomerulosclerosis Is Associated with Massive Oxidation of Plasma Albumin

“…All but one were adults and were presenting a variable degree of proteinuria from 1 to 8 g/d. Patients with membranous glomerulonephritis (MGN) were receiving steroids as single drug (1 to 2 mg/kg) or in combination with immune suppressors (22); in some cases, ACEi (ramipril 5 to 8 mg/m 2 ) had been associated. Membrane Proliferative Glomerulonephritis.…”