There is currently no data to support the use of short-term courses of steroids as the sole therapy to prevent progressive kidney disease in patients with membranous glomerulonephritics (MGN). (Level I evidence)
SUGGESTIONS FOR CLINICAL CARE
(Suggestions are based on level III and IV evidence)
This guideline refers to the use of steroids as sole therapy for patients with membranous glomerulonephropathy. Most studies that have successfully used alkylating agents or cyclosporine to induce remission have used them in combination with steroids delivered either as 2-monthly pulses of methylprednisolone, oral prednisone 0.5 mg/kg per 48 h, or sequential combinations therein. The optimal route remains to be established in clinical studies.
Idiopathic MGN runs a variable course. Most patients do well, with 10-year renal survival of 70%–90% (Schieppati et al 1993). Spontaneous remissions occur in up to 65% of patients (Geddes et al 2000), sometimes months or years after the onset of nephrotic syndrome and a substantial percentage of patients never progress to kidney failure. To avoid possibly unnecessary treatments, most clinical studies have focused on patients thought to be at greater risk for progressive disease. The objective of this guideline is to evaluate the available clinical evidence pertaining to the impact of steroid therapy on renal functional decline in MGN with poor prognostic features.
Databases searched: MeSH terms and text words for Membranous Nephropathy were combined with MeSH terms and text words for steroids. This search was carried out in Medline (1966 to September Week 1 2004). The Cochrane Renal Group Trials Register was also searched for trials of membranous nephropathy not indexed in Medline.