Long-term corticosteroid and dipyridamole treatment of membranoproliferative glomerulonephritis type I in children

Eighteen patients with biopsy-proven membranoproliferative glomerulonephritis (MPGN) type I (16 diffuse, 2 focal) and a minimum of three years of follow-up (median 6.0 years, range 3 to 15.5 years) were treated with corticosteroids combined with dipyridamole. Initial therapy consisted of intravenous methylprednisolone pulses and/or daily oral prednisolone at the dose of 1mg/kg combined with dipyridamole at the dose of 5mg/kg, depending on the disease severity. Corticosteroid dosage was then reduced according to clinical improvement. At the start of therapy, 12 patients had microscopic hematuria or mild proteinuria, three patients had heavy proteinuria and three patients had insufficient renal function. At a median of 53 months of treatment, 89% of the children had normal or mildly abnormal urinary findings with normal renal function. Follow-up biopsy revealed improved active glomerular injury in all children. Although one case progressed to end-stage renal failure, the renal survival of our patients was 94% at 4 to 10 years after clinical onset. No patient suffered a relapse during corticosteroid dosage adjustment, nor did any unacceptable complications arise during the regimen. Eleven patients stopped the regimen because their renal function and urinalysis had normalized, and they remained in remission for a median of 32 months. These results suggest that long-term, tapering and limited use of corticosteroids combined with dipyridamole is useful and safe for children with MPGN type I.