Immunosuppressive treatment in the prevention of renal failure in primary glomerular diseases.

Despite the relative paucity of well controlled studies, there is reason for cautious optimism with respect to favorably influencing the course of certain primary glomerular diseases with pharmacologic therapy. Particularly promising in this regard is the role of corticosteroids in membranous nephropathy, anticoagulant and antithrombotic agents in membranoproliferative glomerulonephritis and high-dose "pulse" steroids, "quadruple therapy" or plasma exchange with immunosuppression in idiopathic crescentic glomerulonephritis. Further controlled trials are urgently needed in the various forms of mesangial proliferative glomerulonephritis, including Berger's disease, in focal and segmental glomerulosclerosis and membranous nephropathy in which reduced GFR or steroid resistance has been demonstrated. It seems quite clear that even a temporary delay in the onset of ESRD, if such can be obtained with a minimum of lasting side effects, is a reasonable goal of therapy considering the expense of maintenance dialysis and transplantation.