Response of type I membranoproliferative glomerulonephritis to pulse methylprednisolone and alternate-day prednisone therapy

Abstract

Sixteen children with biopsy-confirmed type I membranoproliferative glomerulonephritis (MPGN) were treated with six alternate-day intravenous pulses of methylprednisolone followed by single-dose alternate-day prednisone for 12-66 months (mean 37 months). The average length of follow-up was 52 months (range 12-127 months). Compared with pretreatment values, the frequency of hematuria (13/16 vs. 8/16, P < 0.05) and the levels of serum albumin (2.66 +/- 0.69 vs. 3.76 +/- 0.39 g/dl, P < 0.001), creatinine clearance (97 +/- 37 vs. 129 +/- 26 ml/min/1.73 m2, P < 0.001), and proteinuria (5.2 +/- 5.1 vs. 1.0 +/- 0.8 g/day, P < 0.001) were significantly improved after 3 months of therapy. Improvement has persisted through the end of the follow-up period. Repeat kidney biopsies showed a significant reduction in acute changes but an increase in chronic changes. Thirteen patients have been off therapy from 1 to 74 months (mean 20.8 months). Nine have a normal urinalysis, creatinine clearance, and protein excretion. The remainder have normal renal function but proteinuria ranging from 3.2 to 4.3 g/day. The data support the evidence of other investigators that corticosteroid therapy is beneficial in type I MPGN and suggest that initiation with pulse methylprednisolone may promote early stabilization of the disease.

Prognostic factors in children with membranoproliferative glomerulonephritis type I

“…A number of non-randomized studies [17][18][19][20], a report on randomization [21], and our study, which present diverse therapeutic schemes based on methylprednisolone, suggest that such schemes improve the progression to kidney failure and nephrotic syndrome. However, we do not have clear evidence favoring this treatment, and further randomized studies need to be conducted to confirm this theory.…”

Remission of membranoproliferative glomerulonephritis type I with the use of tacrolimus

“…Among the varied steroid regimes studied, the use of prolonged alternate-day oral prednisone therapy appears to be the most favored [6]. Other investigators initiated this regimen following an initial pulse of high-dose intravenous methylprednisolone [8]. In addition to steroids, other therapies used Fig.…”

Long-term follow-up of diffuse membranoproliferative glomerulonephritis type I

“…Several kinds of immunosuppressive therapy thus have been studied and reported [2,4,5,8,11], but no therapy for MPGN has been universally accepted. One reason is that many studies have only examined small sample populations, and so have often combined pediatric and adult groups despite marked differences in the clinical course between these populations.…”

“…However, long-term alternate-day prednisolone and pulse methylprednisolone therapies have improved the prognosis [2,3,4,5]. In Japan, early detection and therapy for MPGN resulting from the school urinary screening program initiated in 1974 have also improved the prognosis [6,7].…”