Steroid-Resistant Idiopathic Nephrotic Syndrome

Abstract

Fifteen patients with idiopathic nephrotic syndrome unresponsive to steroid therapy were treated with azathioprine (4 mg/kg/ day) for periods ranging from 23 to 83 days. Pretreatment biopsies were obtained in each, and four histologic types of glomerulonephritis were found: membranous glomerulonephritis, seven patients; diffuse proliferative glomerulonephritis, four patients; focal glomerulonephritis, two patients; and lobular glomerulonephritis, two patients. None achieved complete remission; two had a partial remission with marked decrease in proteinuria, loss of edema, and increase in serum albumin to near normal levels; three others improved with a lesser decrease in proteinuria and loss of edema, but no rise in serum albumin level. Of the other ten, six remained stable, three deteriorated, and one died. Responders included two with membranous glomerulonephritis, two with proliferative glomerulonephritis, and one with lobular glomerulonephritis. Neither patient with focal glomerulonephritis responded. Azathioprine therapy may be helpful in some patients with idiopathic nephrotic syndrome unresponsive to