PROGNOSIS FOR TREATMENT EFFICACY IN PATIENTS WITH IDIOPATHIC MEMBRANOUS GLOMERULONEPHRITIS
Renal death or end-stage chronic kidney disease are evolved in 20-40% patients with idiopathic membranous glomerulonephritis. But data connecting with pathogenetic therapy effectiveness are controversial and need for additional clarification. Aim of this work was retrospective evaluation of disease natural course and prospective study of different immunosuppressive treatment regimens with effectiveness criteria elaboration. Materials and methods. The natural history of renal disease in the retrospective analysis and under the prospective care after induction therapy different regimens were studied in 96 patients with idiopathic membranous glomerulonephritis. Immunosupressive therapy included the use of oral prednisolone or oral azathioprine or intravenous cyclophosphamide, and intravenous pulse therapy with methylprednisolone and cyclophosphamide. Results. Cyclophosphamide intramuscular therapy or intravenous pulse therapy with methylprednisolone and cyclophosphamide were superior in remission frequency (31.8% and 33.4% accordingly) to oral prednisolone (13.2%) and azathioprine (10.0%). 10-year survival was 37.5% and 38.3% for oral prednisolone and azathioprine without significant difference to untreted group. In cyclophosphamide treated patients 10-year survival was 59.7%. Conclusion. According to multivariate linear regression analysis predictors of inmmunosupressive therapy efficacy were proteinuria more than 3 g/d, absence of arterial hypertension, normal renal function, age of 40 years or less and female sex, absence or mild extracapillary proliferation, tubulointerstitial and fibroplastic changes, cyclophosphamide using.