A case is presented of a woman with idiopathic nephrotic syndrome--mesangioproliferative glomerulonephritis who after a 7-year therapeutic remission developed a rapidly progressing (semilunar) glomerulonephritis with a severe nephrotic syndrome, arterial hypertension, anemia, renal failure. The patient was not influenced by the treatment with ordinary doses of glucocorticosteroids and temporarily improved by the combined "pulse" methylprednisolone, immunosuppressive and heparin treatment. The possible pathogenetic mechanisms which may have played a role in the transition of the idiopathic nephrotic syndrome into a rapidly progressing glomerulonephritis are discussed.
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