Long-term follow-up of atypical membranoproliferative glomerulonephritis: are steroids indicated?

Atypical membranoproliferative glomerulonephritis (MPGN) has been reported to have a good prognosis when treated with corticosteroids. However, this recommendation is based on uncontrolled trials and is associated with many complications. The purpose of our study is to determine whether steroid ther...

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Published in:Pediatric nephrology (Berlin, West) West), 2006-02, Vol.21 (2), p.194-200
Main Authors: Fujita, Teruo, Nozu, Kandai, Iijima, Kazumoto, Kamioka, Ichiro, Yoshiya, Kunihiko, Tanaka, Ryojiro, Hamahira, Kiyoshi, Nakanishi, Koichi, Yoshikawa, Norishige, Matsuo, Masafumi
Format: Article
Language:English
Subjects:
Adolescent
Biopsy
Child
Enzymes
Female
Follow-Up Studies
Glomerulonephritis, Membranoproliferative - drug therapy
Glomerulonephritis, Membranoproliferative - pathology
Hematuria
Hospitals
Humans
Male
Medical prognosis
Microscopy
Nephrology
Patients
Pediatrics
Steroids
Steroids - therapeutic use
Time Factors
Urinalysis
Urine
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Summary:Atypical membranoproliferative glomerulonephritis (MPGN) has been reported to have a good prognosis when treated with corticosteroids. However, this recommendation is based on uncontrolled trials and is associated with many complications. The purpose of our study is to determine whether steroid therapy is indicated for atypical MPGN. The cases of seven patients with atypical MPGN are reported in this study. Urinary abnormalities of five of them were detected by urine screening at school, of two because of macrohematuria. Hypocomplementemia was noted in six patients. All but one patient were treated without corticosteroids, and five with angiotensin-converting enzyme inhibitors (ACEI) and/or the Chinese herbal medicine Sairei-to (TJ-114). One patient recovered spontaneously from proteinuria and was therefore not treated, and one who developed severe proteinuria during observation was treated with corticosteroids. After an average follow-up period of 10.0 years, five patients showed normal urinary findings, one had hematuria and one proteinuria. At the most recent follow-up, the renal function of all patients remained within the normal range, and serum C3 had returned to normal levels in five out of six. These findings suggest that the indication of steroid therapy for atypical MPGN should be re-examined, since most of the patients with atypical MPGN seem to have an excellent prognosis without treatment with corticosteroids.
ISSN:0931-041X
1432-198X
DOI:10.1007/s00467-005-2074-7