CONTROLLED TRIAL OF METHYLPREDNISOLONE AND CHLORAMBUCIL IN IDIOPATHIC MEMBRANOUS NEPHROPATHY

Adults (67) with idiopathic membranous nephropathy and the nephrotic syndrome were randomly assigned to symptomatic treatment only or to a 6-mo. course of methylprednisolone alternated with chlorambucil every other month. Patients were followed for 1-7 yr. At the end of follow-up (mean of 31.4 .+-. 18.2 mo. for the treated group and 37.0 .+-. 22.0 for the control group), 23 of 32 treated patients were in complete or partial remission, as compared with 9 of 30 control patients (P = 0.001). Of the treated patients, 12 were in complete remission, as compared with only 2 of the controls. In the treated group, there were no changes in renal function during follow-up; in the control group the reciprocal of the plasma creatinine level, which is proportional to the creatinine clearance, decreased significantly (P = 0.00017) after 2 yr of follow-up. Side effects were minimal in all treated patients except 2, who were dropped from the study because of peptic ulcer and gastric intolerance to chlorambucil. Steroid and chlorambucil treatment for 6 mo. favors remission of the nephrotic syndrome in adults with idiopathic membranous nephropathy and can preserve renal function for at least some years.