Membranous nephropathy: high-dose alternate-day therapy with prednisone

Fifteen cases were selected for study from 100 consecutive cases of membranous nephropathy diagnosed by renal biopsy and light, immunofluorescence, and electron microscopy. The cases were chosen because during a pretreatment observation period ranging from 8 to 66 months (median, 18 months), the patients' disease state had progressed. Data gathered during this period served as a baseline against which to evaluate the effects of treatment with prednisone; thus, the patients served sequentially as their own controls. All but one of the patients had nephrotic syndrome, and 11 had renal insufficiency. Treatment with prednisone administered on alternate days was accompanied by decreasing proteinuria and increasing serum levels of albumin in all the patients. Healing, defined as proteinuria of no greater than 0.2 grams per 24 hours for at least a year with maintenance of normal creatinine clearance, occurred in eight patients. Renal function, judged by rate of creatinine clearance or level of creatinine in serum, improved in all 11 patients with renal insufficiency; in eight of these, normal function was attained. Poor renal function could not be attributed to diminished blood volume measured by chromium 51 red-blood-cell tag.