Immunosuppressive treatment of Berger's disease

Background: The aim of our study was to determine whether immunosuppressive treatment is effective in preventing and reversing the evolution of Berger's disease toward chronic renal failure. Methods: We studied 20 unselected, consecutive patients with biopsy-proven Berger's disease who met the criteria for disease progression. They had proteinuria, significant histologic changes, persistent hematuria, and red cell casts. The treatment consisted of prednisone in an alternate-day regimen and cyclophosphamide, either in a daily oral administration or in a monthly intravenous pulse injection, both given for a 6-month cycle. Five patients had chronic renal failure (as disclosed by plasma creatinine of 230 ± 71 μmol/L), hypertension, and proteinuria (2.7 ± 0.8 gm/day), whereas the remaining 15 patients had normal renal function (plasma creatinine, 97 ± 18 μmol/L) and less severe proteinuria (1.9 ± 1.1 gm/day). However, even these 15 patients had a significant number of risk factors heralding progression to chronic renal failure. Results: Over an average follow-up of 8.7 ± 3.7 years (range, 5 to 15 years), all patients but one had complete disease remission, including five patients with incipient chronic renal failure. Relapse occurred in two patients who were healed after a repeat treatment cycle. Over the entire follow-up period, no patient progressed to chronic renal failure and plasma creatinine concentration remained stable, even in subjects in whom it was high before treatment (257 ± 79 versus 230 ± 71 μmol/L; p > 0.05). Conclusion: The immunosuppressive treatment of patients with Berger's disease with high probability of progression appears to be effective in the prevention of end-stage renal disease.