Suki W N, Chavez A
Am J Nephrol. 1981;1(1):11-6. doi: 10.1159/000166481.
In a retrospective study, the clinical course of 23 adult patients with documented idiopathic membranous nephropathy was reviewed. These patients included 16 men and 7 women, who were followed for a period of as long as 9 years, 22 patients (95.7%) were nephrotic (proteinuria of 3 g or more in 24 h) and 6 (26%) were hypertensive. 5 patients were treated with prednisone alone, 12 with prednisone and cyclophosphamide, 2 with prednisone and azathioprine and 4 received no treatment. 18 patients achieved complete remission (78.3%). 16 of these (88.9%) were treated with prednisone, or prednisone and cyclophosphamide or azathioprine, and the remaining remitted spontaneously. In 3 additional patients, proteinuria improved with treatment with prednisone and immunosuppression but remained in the nephrotic range in 2, and fell to 1.8 g/day in 1. Patients who failed to respond to steroids showed remarkable improvement when therapy with cyclophosphamide was added. Of the 4 patients not treated, 2 underwent spontaneous remission and 2 developed renal insufficiency. These results suggest a beneficial effect of steroids in the treatment of membranous nephropathy, and suggests further that cyclophosphamide may be effective in patients not responding to steroids alone. Finally, these results suggest that in many patients therapy may have to be prolonged before a remission can be observed.
在一项回顾性研究中，对23例确诊为特发性膜性肾病的成年患者的临床病程进行了回顾。这些患者包括16名男性和7名女性，随访时间长达9年，22例患者（95.7%）为肾病综合征（24小时蛋白尿≥3g），6例（26%）为高血压患者。5例患者仅接受泼尼松治疗，12例接受泼尼松和环磷酰胺治疗，2例接受泼尼松和硫唑嘌呤治疗，4例未接受治疗。18例患者实现完全缓解（78.3%）。其中16例（88.9%）接受了泼尼松、泼尼松与环磷酰胺或硫唑嘌呤联合治疗，其余患者自发缓解。另外3例患者经泼尼松和免疫抑制治疗后蛋白尿有所改善，但2例仍处于肾病范围，1例降至1.8g/天。对类固醇治疗无反应的患者加用环磷酰胺治疗后有显著改善。4例未接受治疗的患者中，2例自发缓解，2例出现肾功能不全。这些结果表明类固醇对膜性肾病的治疗有有益作用，进一步表明环磷酰胺对单独使用类固醇无反应的患者可能有效。最后，这些结果表明，在许多患者中，可能需要延长治疗时间才能观察到缓解。
