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What is the basis for the use of steroids in the treatment of idiopathic membranous nephropathy?

In the past 30 years steroids have been widely employed in the management of primary glomerulopathies. At variance with 'minimal-change nephropathy', in which glucocorticoids are of well-known value, in other forms of immune-mediated glomerulopathies and particularly in idiopathic 'membranous glomerulopathy' results of controlled trials are inadequate or controversial. Retrospective analysis of the data reported in the literature indicates a beneficial effect in some series but appears disappointing in others. Certainly the use of high-dose steroids for a prolonged period of time can expose the patients to serious side effects. The aim of the present review is to critically evaluate the results obtained with the use of steroids in the treatment of 'membranous glomerulopathy' and reexamine the rationale of their use in the light of the new information on the glucocorticoids mechanism of action on the immune system.