ABSTRACT
Objective:To investigate the clinical efficacy and safety of oral glucocorticoid combined with intravenous cyclophosphamide or oral cyclophosphamide in the treatment of idiopathic membranous nephropathy.Methods:According to the random number table method, 50 patients in our hospital were divided into oral cyclophosphamide group (oral group) and intravenous cyclophosphamide group (intravenous group). The oral group was treated with prednisone and compound cyclophosphamide tablets, while the intravenous group was given prednisone and intravenous injection of cyclophosphamide. The 24-hour urinary protein, serum albumin, liver and kidney function and adverse events were observed before treatment and 1, 3, 6 and 12 months after treatment. The remission rate and drug safety of the two groups were compared.Results:After 3 months of treatment, the effective rate of oral group was 40%, which was significantly higher than that of intravenous group (4%). After 6 months of treatment, the effective rate of oral group (52%) was higher than that of intravenous group (44%). After 12 months of treatment, the effective rate of intravenous group (72%) was higher than that of oral group (64%), with no statistically significant difference ( P>0.05). Before treatment, there were no significant differences in albumin, urea nitrogen, creatinine, Cystatin C, glomerular filtration rate and 24-hour urine protein between the oral group and the intravenous group ( P>0.05). After 12 months of treatment, the level of albumin in the oral group and the intravenous group was significantly higher than that before treatment ( P<0.05), and the 24-hour urine protein level was significantly lower than that before treatment ( P<0.05). The total incidence of adverse reactions in the intravenous group was lower than that in the oral group ( P<0.05). Conclusions:Hormone combined with intravenous infusion of cyclophosphamide has better long-term efficacy and higher safety in the treatment of idiopathic membranous nephropathy.
ABSTRACT
Idiopathic membranous nephropathy (IMN) is one of the pathological types of nephrotic syndrome.Besides secondary factors,such as immune system diseases,hepatitis and tumors,the etiology is still unclear.Recent studies have shown that the incidence of IMN is increasing year by year,and the age of onset is gradually younger.Adolescents have become a representative group of new IMN patients.Researches have showed that adolescent idiopathic membrane patients have mild clinical and pathological manifestations,good renal function,and good prognosis.Most patients have fertility requirements,and there are clinical concerns about the application of hormones and immunosuppressive agents.This paper reviews the progress on the clinicopathological manifestation,treatment and prognosis of adolescent IMN patients.
