Membranous glomerulonephritis - gender-related differences of disease course and evaluation of therapy efficiency

Membranous glomerulonephritis (MGN) is the most common glomerular disease leading to nephrotic syndrome in adults. MGN can be primary (idiopathic) or secondary to other diseases. The treatment of MGN can be pathogenic or symptomatic. Pathogenetic treatment is indicated to patients with iMGN or class 5 lupus nephritis and includes a wide range of drugs: corticosteroids, alkylating agents, cyclosporine, tacrolimus, mycophenolate mofetil, ACTH and newer substances, products of gene engineering, such as rituximab and eculizumab. The aim of this study was to evaluate the gender-specific differences in the disease course and to evaluate the effect of the therapeutic schemes in patients with biopsy-proven MGN. We studied 72 subjects with biopsy-proven MGN. The levels of proteinuria, total plasma protein, albumin and renal function were examined at the time of the diagnosis, in its course and at the end of the follow-up. These markers were compared to gender, age, comorbidities and different treatment regimens. We found statistically significant gender-related differences in the levels of proteinuria, total plasma protein and albumin. There was a difference in the full remission rates between genders, but no significant gender difference in the patients that reaching any remission and in the relapse rates. No difference was observed between patients receiving lower doses and high doses of Cyclophosphamide. The results of our study reveal that females have a more favorable disease course with lower proteinuria and a higher chance of reaching complete remission than males. Our data show that treatment with lower doses of Cyclophosphamide leads to equally good results in reducing proteinuria and achieving remission compared to high doses and pulse treatment is a valid option in the treatment algorithm of iMGN.

мембранозный гломерулонефрит, протеинурия, лечение, membranous glomerulonephritis, proteinuria, treatment

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