Mesangial proliferative glomerulonephritis. Natural history and effects of dextran sulfate

We evaluated 246 cases having clinically primary chronic glomerulonephritis and histologically mesangial proliferative glomerulonephritis of varying degrees. 190 patients conservatively followed with serial measurements of GFR served as delineating the natural history. The remaining, randomly selected 56 subjects were treated with Dextran sulfate, a mild anticoagulant, for 7 to 56 months (average, 25.4). 55 cases underwent repeated renal biopsy at the mean interval of 3.3 years. It became evident clinically and morphologically that the severity of diffuse mesangial proliferation and the presence of focal and segmental lesions in more than 20% were two critical determinants of the natural history. All cases with mild mesangial proliferative alteration alone survived more than 10 years, but none of the patients with global sclerosis in more than 50% in the initial biopsy did. 10-year survival rates in mild, and moderate or greater mesangial proliferation with the focal-segmental lesions were 45.0% and 19.3%, respectively. In the treated group, renal function improved or was maintained, along with histologic confirmation in some, during the follow-up period. Moreover, the survival rate of subjects with global sclerosis in more than 50% ameliorated beyond the natural history. Thus, Dextran sulfate appeared promising for a possible suppression of the coagulatory process associated with the focal-segmental lesions.