Fuiano G, Stanziale P, Balletta M, Sepe V, Marinelli G, Comi N, Esposito A, Andreucci V E
Department of Nephrology, Second Faculty of Medicine, Naples, Italy.
Nephrol Dial Transplant. 1989;4(12):1022-9.
The published studies on histological staging and response to steroid therapy of membranous glomerulonephritis are not consistent. We analysed data from 25 adult patients with stage I (group 1, n = 7) and stage II (group 2, n = 18) disease. The interval between clinical onset and admission was similar in the two groups. At admission all patients had normal creatinine clearance; proteinuria averaged 5.4 +/- 4.0 in group 1 and 9.0 +/- 4.0 in group 2 (g/day per 100 ml GFR). All patients received 6 months steroid therapy (months 1-2, 1 mg/kg b.w. per day; month 3-5: 0.65 mg/kg b.w. e.o.d.; month 6, tapering). After this cycle of steroid therapy, proteinuria declined by 84% in group 1 (five patients being in partial remission, i.e. 0.4-2 g/day, and two patients in complete remission, i.e. less than or equal to 0.3 g/day) and by 47% in group 2 (two patients being in complete remission and six in partial remission). Only 1 patient in group 1 relapsed with nephrotic proteinuria after 36 months, and renal function was still normal in all patients at the most recent follow-up (59 +/- 32 months). In contrast, 14 patients in group 2 had nephrotic syndrome and seven renal insufficiency at the most recent follow-up. We conclude that short-term steroid therapy is effective only in patients with early membranous changes.
关于膜性肾小球肾炎的组织学分期及对类固醇治疗反应的已发表研究并不一致。我们分析了25例成年患者的数据，其中I期患者（第1组，n = 7）和II期患者（第2组，n = 18）。两组患者从临床发病到入院的时间间隔相似。入院时所有患者的肌酐清除率均正常；第1组蛋白尿平均为5.4±4.0，第2组为9.0±4.0（g/天每100 ml肾小球滤过率）。所有患者均接受了6个月的类固醇治疗（第1 - 2个月，每天1 mg/kg体重；第3 - 5个月：隔天0.65 mg/kg体重；第6个月，逐渐减量）。经过这一周期的类固醇治疗后，第1组蛋白尿下降了84%（5例患者部分缓解，即0.4 - 2 g/天，2例患者完全缓解，即≤0.3 g/天），第2组下降了47%（2例患者完全缓解，6例患者部分缓解）。第1组仅1例患者在36个月后复发为肾病性蛋白尿，在最近一次随访（59±32个月）时所有患者肾功能仍正常。相比之下，在最近一次随访时，第2组有14例患者患有肾病综合征，7例患者出现肾功能不全。我们得出结论，短期类固醇治疗仅对早期膜性病变患者有效。
