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Clinicopathological Correlations in Idiopathic Nephrotic Syndrome with Membranous Nephropathy
Abstract
The separation of patients with idiopathic nephrotic syndrome into those with lipoid nephrosis and membranous nephropathy on the basis of ultrastructural study of renal biopsy material is supported by contrasts in the natural history and response to therapy of the groups. Nineteen patients with the latter lesion have been followed for periods of up to eleven years. Nine are known to have expired with a mean duration of clinical illness of six years. Nine survivors are known with a mean duration of clinical illness of 5.3 years. Corticosteroid therapy rarely appears to provide sustained clinical improvement. However, remissions with loss of clinical features of the illness have been observed in five patients. Serial renal biopsies indicate the morphologic lesion is usually unchanged or progressive, despite subsidence of proteinuria and clinical remission. In one patient a renal biopsy in her third year of remission showed striking regression of a previously marked membranous change. Morphologic differentiation from renal involvement with systemic lupus erythematosus may be difficult and diagnosis depends on evidence of multisystem disease and additional laboratory studies. Review of reported immunofluorescent studies of biopsy material and comparison with experimental lesions suggest the glomerular membranous lesion is immunologically determined.
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179748 Nephron 1969;6:498–525Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.