Most patients with idiopathic membranous nephropathy have a benign course, but a minority develop severe persistent nephrotic syndrome or end-stage renal failure. The disease appears to have an immunological basis and immunosuppression has been used with some benefit. Unfortunately, treatment can be toxic and not all patients respond. For this reason it would be useful to identify at an early stage those patients who might benefit from treatment. This information could be used to minimize the exposure of patients to unnecessary treatment toxicity. We studied a cohort of 128 patients over a 2-year period. A clear relationship exists between the early response to treatment at one month and the long-term outcome from treatment across a number of treatment types. Those patients who might benefit from treatment and those who are unlikely to benefit, can be clearly distinguished at an early stage.
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