Treatment of proteinuric idiopathic glomerulonephritides in adults: a retrospective survey

A review of the worldwide medical literature was undertaken to determine whether treatment with currently available drugs has been beneficial in patients with glomerulonephritides.

Thirty-five articles, involving 1,653 adult patients with chronic primary glomerulonephritis with proteinuria and/or nephrotic syndrome, were analyzed. The criteria for inclusion of data were strict, and only complete and well-studied cases were included in the analysis. The papers were grouped into prospective controlled trials, retrospective comparisons of treated and untreated patients, and retrospective studies without an untreated group.

Analysis of the data shows that patients with minimal change disease clearly benefited from the administration of corticosteroids and/or cytotoxic drugs, since 89 percent and 79 percent of patients had a complete remission in controlled trials and in retrospective studies, respectively. A low incidence of complete and partial remissions was found in the group of patients with focal segmental glomerulosclerosis, proteinuria disappeared in 19 percent, and only 36 percent of these patients had stable renal function after a mean follow-up period of 6.3 years. The incidence of uremia and the number of patients requiring dialysis were very high. In patients with membraneous glomerulonephritis, conflicting results were obtained in controlled trials, retrospective comparisons, and retrospective studies, since a high percentage of complete and partial remissions was present in treated patients from both controlled and retrospective comparisons, whereas the percentage of complete and partial remission in untreated patients increased as the length of the follow-up period increased. Long-term studies carried out on untreated patients confirmed the high percentage of remissions. These data suggest that it is necessary to await future long-term results from controlled trials in order to determine whether or not corticosteroids alone or associated with cytotoxic drugs have a beneficial effect. Finally, the data from patients with mesangiocapillary glomerulonephritis show that therapy appears to have no beneficial effect on renal function. Nephrologists need new drugs that interfere more decisively with the immune process in the pathogenesis of primary glomerulonephritis.