'Progressive' versus 'indolent' idiopathic membranous glomerulonephritis

There is still controversy about safe and effective therapy for idiopathic membranous glomerulonephritis (MGN). Over 20 years, we have simply observed our patients clinically after diagnosis, and only used aggressive therapy with steroids in high dosage and azathioprine for 21 patients with progressive renal failure. The other 42 were thus classified as 'indolent' MGN. Those with 'progressive' MGN had heavier proteinuria and worse renal function on presentation, but the overlap was considerable. Patients with progressive MGN were treated after 1-4 years. All responded promptly, and 5 years after presentation ail were alive, and only one was on dialysis. By 10 years, most were still alive, and of these most were off dialysis. In five patients, dialysis was delayed by several years. There were two deaths on dialysis, and three other deaths, mostly in older patients. All but one patient with indolent MGN remained stable on symptomatic treatment only, for at least 5 years after presentation. In many, proteinuria fell to insignificant levels over 4 years. In these remitting patients, there was a prevalence of thyroid disease (7), rheumatoid disease (3) and nephrotic presentation in pregnancy (4). After 6-10 years three patients developed worsening proteinuria and renal failure. Five older patients died from unrelated causes.