Hay N M, Bailey R R, Lynn K L, Robson R A
Department of Nephrology, Christchurch Hospital.
N Z Med J. 1992 Dec 9;105(947):489-91.
to study prospectively patients presenting with membranous nephropathy.
the outcome of 51 patients (33 male; mean age 50.8 SD 17.7 years; 49 caucasian, two Maori), aged 14 years and over, with membranous nephropathy was studied prospectively. The patients were enrolled between 1 July 1972 and 30 June 1991. Patients with systemic lupus erythematosus were excluded. Membranous nephropathy was secondary to drug therapy in eight (gold 3, nonsteroidal antiinflammatory drug 3, penicillamine 1, captopril 1). All patients were hepatitis B surface antigen negative. The majority of patients did not receive immunosuppressive therapy.
forty-seven (92%) presented with the nephrotic syndrome, eight (16%) with a plasma creatinine > or = 0.15 mmol/L and 28 (55%) with hypertension. The patients were followed for a mean of 5.4 years, the median being 3.9 years and range four months-19 years. The 10 year cumulative renal survival was estimated to be 78% and overall survival 66%. Six patients have entered a renal replacement programme and six have died of nonrenal causes. Of the remaining 39, eight have renal insufficiency, 27 hypertension and 22 proteinuria. Complete remission occurred in 17 (33%)-11 spontaneously, four following withdrawal of the offending drug and two after immunosuppressive therapy. Poor prognostic indicators at presentation included renal insufficiency, need for antihypertensive therapy, pathological stage IV on renal biopsy and older age.
membranous nephropathy is an indolent disease with a good chance of spontaneous remission. In most patients immunosuppressive treatment appears unwarranted.
对膜性肾病患者进行前瞻性研究。
对51例年龄在14岁及以上的膜性肾病患者进行前瞻性研究（33例男性；平均年龄50.8岁，标准差17.7岁；49例白种人，2例毛利人）。患者于1972年7月1日至1991年6月30日入组。排除系统性红斑狼疮患者。8例膜性肾病继发于药物治疗（金制剂3例、非甾体抗炎药3例、青霉胺1例、卡托普利1例）。所有患者乙肝表面抗原均为阴性。大多数患者未接受免疫抑制治疗。
47例（92%）表现为肾病综合征，8例（16%）血肌酐≥0.15 mmol/L，28例（55%）有高血压。患者平均随访5.4年，中位数为3.9年，范围为4个月至19年。估计10年肾脏累积生存率为78%，总生存率为66%。6例患者进入肾脏替代治疗程序，6例死于非肾脏原因。其余39例中，8例有肾功能不全，27例有高血压，22例有蛋白尿。17例（33%）完全缓解——11例自发缓解，4例在停用致病药物后缓解，2例在免疫抑制治疗后缓解。就诊时不良预后指标包括肾功能不全、需要抗高血压治疗、肾活检病理分期为IV期及年龄较大。
膜性肾病是一种进展缓慢的疾病，有较好的自发缓解机会。在大多数患者中，免疫抑制治疗似乎没有必要。
