Glomerular tip lesion in the 1962–66 Medical Research Council trial of prednisone in the nephrotic syndrome

Abstract

A multi-centre controlled trial of prednisone in the nephrotic syndrome in adults was run by the Medical Research Council between 1962 and 1966. Sections of renal biopsies and necropsy kidneys from the trial had been kept. These were restained 25 years later with periodic acid-methenamine silver and examined for the glomerular tip lesion, an abnormality of the kidney described after the trial in patients with the nephrotic syndrome. The glomerular tip lesion was found in material from 10 patients, representing 7% of 150 patients with the nephrotic syndrome and glomerulonephritis. In the trial, seven had been classified as minimal-change nephropathy and three as proliferative glomerulonephritis. Detailed follow-up was limited but it was known that two patients died shortly after presentation, not, apparently, from progression of the glomerular disorder; that none of the others had progressed to renal failure, at least for the duration of follow-up of the trial, 2-4 years; and that those classified as minimal-change nephropathy appeared to have behaved clinically as though they had minimal-change nephropathy. These findings show that at least one adult series of minimal-change nephropathy has contained cases of the glomerular tip lesion but that clinically this may not be an important error as the conditions behave similarly. A more important error may be to call the glomerular tip lesion a proliferative glomerulonephritis, which may lead the clinician to withhold steroids.