Abstract
Here we report a boy's case of idiopathic membranous nephropathy freshly found by screening urinalysis at school. Recently, some children with the disease have been found in the same way, although the disease itself is not so common at school age. The diagnosis was made by serological tests and renal histology. We started the treatment with dypiridamol, heparin, and predonisolone (60mg/m2/day), since the patient met the criteria of nephrotic syndrome. The amount of urinary protein began reducing in two weeks and returned to within normal range in four months. Second biopsy at the ninth month revealed that the glomerular lesion, evaluated by Ehrenreich & Churg's criteria for electron microscopic findings, progressed to stage IV from stage II. In adult cases, it usually takes about 1 or 2 years to progress to stage IV from stage I or II, and about 4 or 5 years to become normal. In this case, predonisolone may have hastened the recovery of glomerular basement membrane, although the histological findings are not yet normal. Concerning the risk of relapse, tapering and termination of predonisolone therapy should be carefully considered. Generally speaking, the prognosis of this disease in childhood is better than that in adulthood. Some patients show remission in natural course, but others show nephrotic syndrome or chronic renal failure. That's why the treatment of this disease has not yet been standardized. Therefore, we consider it is necessary to accumulate case reports including clinical course and histology, and try to do controlled clinical study in pediatric patients.
