Conventional treatment of idiopathic nephrotic syndrome and membranous nephropathy in adults.

This article is a review of the results of corticosteroid and immunosuppressive treatment in adults with idiopathic nephrotic syndrome. Adults with minimal-change nephropathy usually require a prolonged administration of corticosteroids to achieve remission which, in itself, carries the risk of severe and even life-threatening complications. Therefore, intravenous high-dose steroid pulses, alternate-day prednisone, short courses with cytotoxic agents and long-term administration of azathioprine have been suggested as alternatives to the classical prolonged corticotherapy. While most patients with focal-segmental glomerulosclerosis do not respond to short-term prednisone, almost half of the patients with nephrotic syndrome will attain remission with a more prolonged administration of corticosteroids and/or cytotoxic agents. A six-month course of methylprednisolone and chlorambucil preserves renal function and reduces the proteinuria in many patients with membranous nephropathy, even in the presence of initial renal insufficiency. Thus, there is growing evidence that corticosteroids and/or immunosuppressive agents can favorably alter the natural course of disease in many patients with idiopathic glomerulonephritis. However, these agents have a low therapeutic index. Further studies are needed to find more effective and less toxic treatment approaches in patients with primary glomerulonephritis.