A Long Term Follow-up of a Case of Idiopathic Membranous Glomerulonephritis

A 42 year.old woman was admitted to Nagasaki University Hospital with complaint of general edema on Jan, 1970. She had been treated for general edema at a nearby hospital since March 1968. On admission, she was diagnosed as nephrotic syndrome, but her renal function was within normal. After the treatment of steroid and cyclophosphamide, she became the condition of complete remission in Dec. 1971. In July 1980 (8 years and 7 months after complete remission and 6 years and 5 months after termination of steroid therapy), she was readmitted to our hospital with general edema. No predisposing factor was found. At the second admission, she was diagnosed as nephrotic syndrome again, and her renal function was slightly decreased. The lightmicroscopic (LM) findings of renal biopsy specimens at the first admission (Jan. 1970) showed thickening of the glomerular basement membrane (GBM) without cell proliferation. (Electronmicroscopic (EM) findings showed thickening of basementmembrane associated with electron dense deposits and some already lucent deposits in subepithelial areas and completely fused foot processes of epithelial cells.) On the other hand, during the period of complete remission (April 1967), LM findings changed to show almost normal GBM and also EM findings changed to show few small subepithelial electron dense deposits and smooth, but not thickened, glomerular basement membrane. Regeneration of foot processes of epithelial cells was observed. At the time of relapse (OCT. 1980), LM findings showed slight thickening of GBM again and EM findings showed subepithelial electron dense deposits and foot processes of epithelial cells were fused. To sum up, this is a case of membranous glomerulonephritis that showed relapse not only clinically but histologi-cally after a long term of remission.