Schieppati A, Mosconi L, Perna A, Mecca G, Bertani T, Garattini S, Remuzzi G
Mario Negri Institute for Pharmacological Research, Bergamo, Italy.
N Engl J Med. 1993 Jul 8;329(2):85-9. doi: 10.1056/NEJM199307083290203.
Defining the most appropriate treatment for patients with idiopathic membranous nephropathy is a matter of controversy. The course of the disorder is often benign, and the immunosuppressive regimens used in some patients have uncertain benefits and substantial risks. We studied the natural history of idiopathic membranous nephropathy in patients who received only symptomatic therapy.
We prospectively studied 100 consecutive patients (68 men and 32 women; mean [+/- SD] age, 51 +/- 17 years) with biopsy-proved idiopathic membranous nephropathy. The patients received diuretic or antihypertensive drugs as needed, but no glucocorticoid or immunosuppressive drugs. We examined the patients and measured their urinary protein excretion and serum creatinine concentrations every 6 months for a mean of 52 months.
Twenty-four (65 percent) of the 37 patients followed for at least five years had complete or partial remission of proteinuria; in 6 others (16 percent), end-stage renal disease developed, and they required dialysis. As calculated by the Kaplan-Meier method, the estimated probability (+/- the standard error of the estimate) of retaining adequate kidney function was 88 +/- 5 percent after five years and 73 +/- 7 percent after eight years. The prognosis was poorer in men and in patients over 50 years of age, but not in patients with the nephrotic syndrome, hypertension, or hypercholesterolemia.
Most untreated patients with idiopathic membranous nephropathy maintain renal function for prolonged periods and are likely to have spontaneous remission. These results do not support the use of glucocorticoids and immunosuppressive drugs in patients with idiopathic membranous nephropathy.
确定特发性膜性肾病患者最合适的治疗方法存在争议。该疾病的病程通常是良性的，一些患者使用的免疫抑制方案益处不明确且风险很大。我们研究了仅接受对症治疗的特发性膜性肾病患者的自然病程。
我们前瞻性地研究了100例经活检证实为特发性膜性肾病的连续患者（68例男性和32例女性；平均[±标准差]年龄为51±17岁）。患者按需接受利尿剂或降压药治疗，但未使用糖皮质激素或免疫抑制药物。我们每6个月对患者进行检查，并测量其尿蛋白排泄量和血清肌酐浓度，平均随访52个月。
在随访至少五年的37例患者中，24例（65%）蛋白尿完全或部分缓解；另外6例（16%）发展为终末期肾病，需要透析。根据Kaplan-Meier方法计算，五年后保留足够肾功能的估计概率（±估计值的标准误差）为88±5%，八年后为73±7%。男性和50岁以上患者的预后较差，但肾病综合征、高血压或高胆固醇血症患者的预后并非如此。
大多数未经治疗的特发性膜性肾病患者肾功能可长期维持，且可能会自发缓解。这些结果不支持对特发性膜性肾病患者使用糖皮质激素和免疫抑制药物。
