MON-028 PATHOLOGICALLY PROVEN COMPLETE CURE OF IDIOPATHIC MEMBRANOUS GLOMERULONEPHRITIS BY METHYLPREDNISOLONE PULSE THERAPY

Abstract

MGN is the second most common cause of nephrotic syndrome in adults, with FSGS recently becoming the most common, however there is no cure for idiopathic MGN and treatment focus on conservative methods such as salt restriction, blood thinning agents, ARB etc. Sometimes corticosteroids, cyclophosphamide, chlorambucil, cyclosporine-A, tacrolimus, MMF, Rituximab etc are tried with mixed results. Recently we have tried methylprednisolone pulse therapy in 7 cases and follow up renal biopsy were performed after 1 year of therapy. Age distribution from 1 to 61 (mean37) year old. Methylprednisolone pulse were tried by Cho’s method (Andreucci; New Therap Strat Nephrol, Kluwer Acad.Pub 1990). One cycle of MP pulse consist of methylprednisolone 20-30mg/kg (max1,000mg)/day mixed at 250ml amino acids solution for 3 consecutive days at 2 weeks interval. We tried 10 cycles. Between pulse therapy we tried deflazacort 0.5mg/kg/day and ARB were given every day. All 7 cases showed complete response clinically and complete dissolution of subepithelial deposits although sclerotic lesions were persisted pathologically. Two pediatric cases ages 1 and 7 showed completely cured clinically and pathologically. No major side effects were noted except one case developed cataract although minor side effects such as moon face, mild abdominal striae were noted. No relapses during 3 years follow up. In conclusion, further studies are needed. However methylprednisolone pulse therapy might be a promising initial treatment method in idiopathic MGN without noticeable side effects before considering secondary drugs such as alkylating agents, calcineurin inhibitors, Rituximab etc. Follow up renal biopsy is mandatory when deciding to stop oral steroid therapy.