IDIOPATHIC MEMBRANOUS NEPHROPATHY

Abstract

The clinical and histopathological features of 37 patients with idiopathic membranous nephropathy were presented. Males were 4 times as commonly affected as females and the age at presentation ranged from 9-70 yr. The period of observation varied from 3 mo.-23 yr. Patients [28(76%)] presented with the nephrotic syndrome and 9 patients (24%) presented with nonnephrotic proteinuria. Of the patients presenting with the nephrotic syndrome, 7 (25%) were in remission, 7 (25%) remained nephrotic, 9 (32%) showed only proteinuria and 5 (18%) were dead or on dialysis. Altogether 8 patients (28%) developed renal failure. The 9 patients who presented with non-nephrotic proteinuria appeared to do better and none developed renal failure. The occurrence of spontaneous remission makes assessment of benefit from immunosuppressive therapy difficult. Oral prednisone, cyclophosphamide and azathioprine had no significant therapeutic properties in this condition. Histological assessment confirmed the occurrence of mild (Grade 1) changes in patients biopsied soon after presentation and tubular atrophy increased with the duration of illness. Immunofluorescence confirmed deposition of mainly Ig[immunoglobulin]G and complement. Repeat biopsies in 14 patients showed no histological improvement and remission was not accompanied by resolution of histological abnormalities.