Q J Med 1999; 92: 401-406
© 1999 Association of Physicians
Clinical features and treatment outcome of idiopathic membranous nephropathy in Chinese patients
From the Division of Nephrology, University Department of Medicine, Queen Mary Hospital, Hong Kong
Received 17 June 1998 and in revised form 7 May 1999
Dr Sydney Tang, Division of Nephrology, University Department of Medicine, Queen Mary Hospital, Pokfulam, Hong Kong
We retrospectively studied the clinical course and treatment outcome of idiopathic membranous nephropathy (IMN) amongst 38 Chinese patients (25 male, 13 female, age 51.6±14.6 years, follow-up duration 58.2±51.1 months) who presented over a 10-year review period. Eight never received any form of specific treatment (group I), seven received oral corticosteroid alone for 6–9 months (group II), 17 were given corticosteroid plus cyclophosphamide for 6–12 months (group III), and six were treated with methylprednisolone alternating with chlorambucil every other month for 6 months (group IV). No untoward effect from drugs sufficient to alter the dosage used was recorded. After 6 months of treatment, over 50% of patients went into remission: a significant reduction in proteinuria (p=0.01, 0.01, 0.02) with a corresponding rise in serum albumin levels (p=0.01, 0.01, 0.04) was observed in groups II, III, and IV, respectively, but not in group I. During follow-up, one patient in each of groups I, III, IV, and two of group II developed renal function deterioration, which correlated with an abnormal presenting serum creatinine. In six group I and eight group III patients who have been followed for at least 5 years, there was progressive reduction in proteinuria in group III (p<0.05), but not in group I: serum creatinine has remained unchanged in both groups. IMN runs a benign course in Chinese patients in Hong Kong, with 2.6% of patients going into end-stage renal failure during the study period. Contrary to reports in Caucasians, there is similar treatment response to steroid alone or a combination of steroid and cytotoxic agents.