LONG-TERM PROGNOSIS OF IDIOPATHIC MEMBRANOUS GLOMERULONEPHRITIS - STUDY OF 116 UNTREATED PATIENTS

One hundred sixteen patients, mainly adults, with idiopathic membranous glomerulonephritis were studied to evaluate their clinical course and long-term prognosis. The onset was marked by a nephrotic syndrome in 88 patients (75.8 per cent) and by a proteinuria without the nephrotic syndrome in 28 patients (24.2 per cent). Clinical remission occurred in 23.4 per cent of cases, clinical improvement in 14.6 per cent, renal insufficiency in 19 per cent (with end-stage renal failure in 9.5 per cent) and the condition remained unchanged in 43 per cent. The actuarial survival curve shows that 76 per cent of the patients were alive at 10 years. Twenty-five per cent of the patients had hypertension during the course of the membranous glomerulonephritis. Seven women had nine pregnancies after the diagnosis of membranous glomerulonephritis was made, with successful deliveries in seven. Renal vein thrombosis was present in five of 16 patients examined for it. Glomerular lesions were classified into three groups, according to the classification of Bariety et al. At the first biopsy, 22 patients were classified as having type I lesions, 79 as having type II lesions and 15 as having type III lesions. The mean interval between discovery of the disease and renal biopsy according to the type of glomerular lesions, is shorter in patients with type I lesions than in those with type II and III lesions. Clinical improvement and clinical remission are more frequent in those with type I lesions than in those with type II and type III lesions. End-stage renal failure was never encountered in those with type I lesions and was present in 13 per cent of those with type II lesions and 7 per cent of those with type III lesions. The different histologic types can correspond to a progression of lesions with time but not to a progressive severity of the disease. In two cases there was complete resolution of the lesions and recovery of the normal appearance of the capillary wall. © 1978.