1541 EXAMPLE OF THE EFFICACY OF PREDNISONE IN THE CONTROL OF TYPE I MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS

Controversy exists as to the utility of prednisone in the treatment of membranoproliferative glomerulonephritis (MPGN). Two patients with Type I disease were treated at the onset of their disease with 2 mg/kg/day of prednisone in divided doses for 2 weeks and then maintained on every-other-day therapy in decreasing doses for 4 & 6 years. In the first month, serum levels of C3 and factor B became normal and C3NeF disappeared. In the first 2 years, creatinine clearances increased from 40 & 51 to 95 & 100 cc/min; proteinuria decreased from 8 and 11 to 0.5 and 0.75 grams/24 hrs; and total serum proteins rose from 4.4 & 4.1 to 6.8 and 7.8 g%. Initially, edema was minimized with lasix therapy while blood pressure was controlled with the aid of hydralazine, aldomet, and propranolol. After 3 & 4 years, all medications except prednisone were withdrawn without change in clinical or laboratory findings. After 4 & 6 years, prednisone therapy was tapered and discontinued. Within 30 and 60 days, C3 and factor B levels decreased by 50%, C3NeF returned, creatinine clearances decreased by 44%, proteinuria increased to 4 and 4.5 g/24 hrs, and blood pressure rose to levels greater than the 95th percentile for age. Prednisone was reinstituted on a daily schedule; in 3 months, all findings returned to “near normal” again. These data suggest that prednisone was important in controlling the activity of MPGN in these 2 patients. The possibility that both patients had spontaneous remissions and relapses coincident with the changes in prednisone is unlikely.