Immunosuppression and outcome in idiopathic membranous nephropathy

From 1986 to 1996, 53 patients with idiopathic membranous nephropathy (IMN) presented to the Glasgow Royal Infirmary renal unit: 19 (36%) were treated because of progressive disease. We compared outcomes of treated and untreated patients with 37 historical and untreated controls. Five- and 10-year survival rates off dialysis were 83.5 and 53.5%, respectively. At the end of a mean observation period of 5.9 years, 47% of patients were in remission, 13% had reached end-stage renal failure, 15% had died, 13% had persistent proteinuria but stable renal function, and 11% had declining renal function. These results are better than those in historical controls, with a reduction in the number of patients reaching ESRF (13% vs. 22%), a larger proportion of patients achieving remission (47% vs. 30%) and smaller numbers of patients with declining renal function (11% vs. 19%) at the end of a similar follow-up period. These data suggest that the use of immunosuppression in selected patients with IMN improves prognosis, although the results did not achieve statistical significance.