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Membranous nephropathy in childhood and its treatment

  • Nephrology Review
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Abstract

Membranous nephropathy is predominantly a disease of middle-aged and elderly individuals, and is thus rather an uncommon finding in proteinuric and nephrotic children. In children, it differs in several important respects from the disease as seen in adults: an apparent associated cause is more common, macroscopic haematuria is seen quite frequently, a relapsing course is more often noted, renal venous thrombosis is not found and evolution into renal failure is the exception. Nevertheless, a proportion of children with membranous nephropathydo evolve into renal failure, and their management is discussed with particular reference to recent papers on the treatment of membranous nephropathy in adults. An aggressive search for associated disease is worthwhile in children, and one should wait to see what the evolution or proteinuria and renal function may be. If a progressive course becomes evident, then a trial of treatment with corticosteroids is worthwhile, but if this is ineffective then a more aggressive approach involving the use of alkylating agents may be justified. It remains undetermined what the best regime in children and adolescents may be.

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References

  1. Churg J, Sobin LH (1982) Renal disease. Classification and atlas of glomerular diseases. Igaku Shoin, Tokyo, pp 54–65

    Google Scholar 

  2. Couser WG (1986) In situ formation of immune complexes and the role of complement activation in glomerulonephritis. Clin Immunol Allergy 6: 287–306

    Google Scholar 

  3. Couser WG, Abrass CK (1988) Pathogenesis of membranous nephropathy. Annu Rev Med 39: 517–530

    Google Scholar 

  4. Brentjens JR, Andres GA (1989) Interaction of antibodies with renal cell surface antigens. Kidney Int 35: 954–968

    Google Scholar 

  5. Border WA, Ward HJ, Kamil ES, Cohen AH (1982) Induction of membranous nephropathy in rabbits by administration of an exogenous cationic antigen. Demonstration of a pathogenic role for electrical charge. J Clin Invest 69: 451–461

    Google Scholar 

  6. Salant D, Quigg RJ, Cybulsky AV (1989) Heymann nephritis: mechanisms of renal injury. Kidney Int 35: 976–984

    Google Scholar 

  7. Hänsch GM, Torbohm I, Rother K (1987) Chronic glomerulonephritis: inflammatory mediators stimulate the collagen synthesis in glomerular epithelial cells. Int Arch Allergy Appl Immunol 88: 139–143

    Google Scholar 

  8. Barnett H (1976) The natural and treatment history of glomerular diseases in children — what can we learn from cooperative studies? Proceedings of the VIth Congress of the ISN. Karger, Basel, pp 470–485

    Google Scholar 

  9. Takekoshi Y, Tanaka M, Shida N, Satake Y, Aheki Y, Matsumoto S (1978) Strong association between membranous nephropathy and hepatitis B surface antigenaemia in Japanese children. Lancet II: 1065–1068

    Google Scholar 

  10. Levy M, Kleinknecht C (1980) Membranous glomerulonephritis and hepatitis B infection. Nephron 26: 259–265

    Google Scholar 

  11. Seggie J, Nathoo K, Davies PG (1984) Association of hepatitis B (HBs) antigenaemia and membranous glomerulonephritis in Zimbabwean children. Nephron 38: 115–119

    Google Scholar 

  12. Wiggelinkhuizen J, Sinclair Smith C, Stannard LM, Smuts H (1983) Hepatitis B virus associated membranous glomerulonephritis. Arch Dis Child 58: 488–496

    Google Scholar 

  13. Hsu H-C, Lin G-H, Chang M-H, Chen C-H (1983) Association of hepatitis B surface (HBs) antigenemia and membranous nephropathy in children in Taiwan. Clin Nephrol 20: 121–129

    Google Scholar 

  14. Brzosko WJ, Krawczynski K, Nazarewicz T, Morzycka M, Novoslawski A (1974) Glomerulonephritis associated with hepatitis B surface antigen immune complexes in children. Lancet II: 478–482

    Google Scholar 

  15. Vecchio-Blanco C del, Polito C, Vaporaso Gado R del, Busachi CA, Coltori M, Toro R di (1983) Membranous glomerulopathy and hepatitis B virus (HBV) infection in children. Int J Pediatr Nephrol 4: 235–238

    Google Scholar 

  16. Navarro M, Meseguer CG, Larrausi M (1982) Hepatitis B antigenemia and nephropathy in children. Int J Pediatr Nephrol 3: 136–139

    Google Scholar 

  17. Kaschula ROC, Uys CJ, Kuijten RH, Dale JRP, Wiggelinkhuizen J (1974) Nephrotic syndrome of congenital syphilis. Biopsy studies in four cases. Arch Pathol 97: 289–296

    Google Scholar 

  18. O'Regan S, Fong JSC, Chadarevian JP de, Rishikof JR, Drummond KN (1976) Treponemal antigens in congenital and acquired syphilitic glomerulonephritis. Ann Intern Med 85: 325–327

    Google Scholar 

  19. Kleinknecht C, Habib R (1987) Membranous glomerulonephritis. In: Holliday M, Barratt TM, Vernier RL (eds) Pediatric kidney disease. Williams and Wilkins, Baltimore, pp 462–470

    Google Scholar 

  20. Cahen R, Francois B, Trolliet P, Gilly J, Parchoux B (1989) Aetiology of membranous glomerulonephritis: a prospective study of 82 adult patients. Nephrol Dial Transplant 4: 172–180

    Google Scholar 

  21. Adu D, Cameron JS (1989) Aetiology of membranous nephropathy (letter). Nephrol Dial Transplant 4: 757–760

    Google Scholar 

  22. Pickering RJ, Michael AF, Herdman R, Good A, Gewurz H (1971) The complement system in chronic glomerulonephritis: three newly associated aberrations. J Pediatr 78: 30–43

    Google Scholar 

  23. Day NK, Geiger H, McLean R, Michael A, Good RA (1973) C2 deficiency. Development of lupus erythematosus. J Clin Invest 52: 1601–1607

    Google Scholar 

  24. Levy PR, Jao W (1974) Nephrotic syndrome in association with renal vein thrombosis in infancy. J Pediatr 85: 359–365

    Google Scholar 

  25. Llach F, Papper S, Massry SG (1980) The clinical spectrum of renal vein thrombosis: acute and chronic. Am J Med 69: 819–827

    Google Scholar 

  26. Derow HA, Schlesinger MJ, Savitz HA (1939) Chronic progressive occlusion of the inferior vena cava and the renal and portal veins with the clinical picture of nephrotic syndrome. Report of a case and review of the literature. Arch Intern Med 63: 626–647

    Google Scholar 

  27. Tsao YC, Chan WC, Gibson JP (1966) Persistent proteinuria in children. Arch Dis Child 44: 443–453

    Google Scholar 

  28. Olbing H, Greifer I, Bennet BP, Bernstein J, Spitzer A (1973) Idiopathic membranous nephropathy in children. Kidney Int 3: 381–390

    Google Scholar 

  29. Trainin EB, Boichis H, Spitzer A, Greifer I (1976) Idiopathic membranous nephropathy. Clinical course in children. NY State J Med 76: 357–360

    Google Scholar 

  30. Ramirez F, Brouhard BH, Travis LB, Ellis EN (1982) Idiopathic membranous nephropathy in children. J Pediatr 101: 677–681

    Google Scholar 

  31. Latham P, Poucell S, Koresaar A, Arbus G, Baumal R (1982) Idiopathic membranous glomerulopathy in Canadian children: a clinicopathologic study. J Pediatr 101: 682–685

    Google Scholar 

  32. Kleinknecht C, Levy M, Gagnadoux M-F, Habib R (1979) Membranous glomerulonephritis with extra-renal disorders in children. Medicine (Baltimore) 58: 219–228

    Google Scholar 

  33. Davison AM, Cameron JS, Kerr DNS, Ogg CS, Wilkinson R (1984) The natural history of renal function in untreated membranous nephropathy. Clin Nephrol 22: 61–67

    Google Scholar 

  34. Noel LH, Zanetti M, Droz D, Barbanel C (1979) Long term prognosis of idiopathic membranous glomerulonephritis. Am J Med 66: 82–90

    Google Scholar 

  35. Honkanen E (1986) Survival in idiopathic membranous glomerulonephritis. Clin Nephrol 25:122–125

    Google Scholar 

  36. Zucchelli P, Ponticelli C, Cagnoli L, Passerini P (1987) Long-term outcome of idiopathic membranous nephropathy with nephrotic syndrome. Nephrol Dial Transplant 2: 73–78

    Google Scholar 

  37. Cameron JS (1988) The long term outcome of glomerular diseases. In Schreier RW, Gottschalk CW (ed) Strauss and Welt's diseases of the kidney. Little Brown, Boston, pp 2127–2189

    Google Scholar 

  38. Kobayashi Y, Tateno S, Shigematsu H, Hiki Y (1982) Prednisone treatment in non nephrotic patients with idiopathic membranous nephropathy. A prospective study. Nephron 30: 210–219

    Google Scholar 

  39. Schena FP, Cameron JS (1988) Treatment of proteinuric idiopathic glomerulonephritides in adults: a retrospective survey. Am J Med 85: 315–326

    Google Scholar 

  40. Collaborative study of the adult idiopathic nephrotic syndrome (1979) A controlled study of short term prednisone treatment in adults with membranous nephropathy. N Engl J Med 301: 1301–1306

    Google Scholar 

  41. Ponticelli C, Zucchelli P, Passerini P, Cagnoli L, Cesana B, Pozzi C, Pasquali S, Imbasciati E, Grassi C, Redaelli B, Sasdelli M, Locatelli F (1989) A randomized trial of methylprednisolone and chlorambucil in idiopathic membranous nephropathy. N Engl J Med 320: 8–13

    Google Scholar 

  42. Cattran DC, Delmore T, Roscoe J, Cole E, Cardella C, Charron R, Ritchie S (1989) A randomized controlled trial of prednisone in patients with idiopathic membranous nephropathy. N Engl J Med 320: 210–215

    Google Scholar 

  43. Cameron JS, Healy MJR, Adu D (1990) The Medical Research Council trial of short term high dose alternate day prednisolone in idiopathic membranous nephropathy with a nephrotic syndrome in adults. Q J Med Jan 1990!

  44. Mathieson PW, Turner AN, Maidment CGH, Evans DJ, Rees AJ (1988) Prednisolone and chlorambucil treatment in idiopathic membranous nephropathy with deteriorating renal function. Lancet II: 869–872

    Google Scholar 

  45. Vosnides G, Edipidis K, Sotsiou F, Papadakis G, Siakotos M, Lemoniatou H, Kaloheretis P, Billis A (1987) Poor response of idiopathic membranous glomerulonephritis (I. M G. N.) to alternated courses of steroids and chlorambucil (abstract). Kidney Int 31: 863

    Google Scholar 

  46. Warwick G, Boulton-Jones JM (1988) Immunosuppression for membranous nephropathy (letter). Lancet II: 1361

    Google Scholar 

  47. Wetzels JFM, Hoitsma AJ, Koene RAP (1989) Immunosuppression for membranous nephropathy (letter). Lancet I: 211

    Google Scholar 

  48. Guesry P, Lenoir G, Broyer M (1978) Gonadal effects of chlorambucil given to prepubertal and pubertal boys for nephrotic syndrome. J Pediatr 92: 299–303

    Google Scholar 

  49. West ML, Jindal KK, Bear RA, Goldstein MB (1987) A controlled trial of cyclophosphamide in patients with membranous glomerulonephritis. Kidney Int 32: 579–584

    Google Scholar 

  50. Hopper J (1989) Prednisone in the treatment of idiopathic membranous nephropathy (letter) N Engl J Med 321: 260–261

    Google Scholar 

  51. Ponticelli C, Zucchelli P, Passerini P (1987) Therapy of idiopathic membranous nephropathy. Springer Semin Immunopathol 9: 431–440

    Google Scholar 

  52. Short CD, Solomon LR, Gokal R, Mallick NP (1987) Methylprednisolone in patients with membranous nephropathy and declining renal function. Q J Med 65: 929–940

    Google Scholar 

  53. Williams PS, Bone JM (1989) Immunosuppression can arrest progressive renal failure due to idiopathic membranous glomerulonephritis. Nephrol Dial Transplant 4: 181–186

    Google Scholar 

  54. Manos J, Short CD, Acheson EJ, Dyer P, Lawler W, Mallick NP, Williams G (1982) Relapsing idiopathic membranous nephropathy. Clin Nephrol 18: 286–292

    Google Scholar 

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Cameron, J.S. Membranous nephropathy in childhood and its treatment. Pediatr Nephrol 4, 193–198 (1990). https://doi.org/10.1007/BF00858840

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