Clinical study on the treatment of idiopathic membranous nephropathy with different dosage of corticosteroid combined with cyclosporine A / 中华肾脏病杂志

ABSTRACT

Objective To evaluate the efficacy and safety of different doses of prednisone combined with cyclosporine A(CSA) on the treatment of idiopathic membranous nephropathy (IMN). Methods The data of 64 patients with nephrotic syndrome (NS) diagnosed as IMN by renal biopsy were retrospectively analyzed. Median follow?up time was 10 (7, 19) months. The subjects were divided into 2 groups according to different prednisone dosage. Thirty?two cases were in the low?dose groupprednisone 0.15 mg·kg-1·d-1+CSA, and 32 cases in the moderate?dose groupprednisone 0.4?0.5 mg· kg-1·d-1+CSA. Clinical and laboratory data were collected at baseline, 1, 3, and 6 months after treatment. During follow?up, cumulative recurrence rate and adverse reactions after treatment were recorded. Results Serum albumin (sALB) were significantly increased and 24 h urinary protein (24hUP) significantly decreased after treatment for 1, 3, 6 months compared with baseline data in the two groups. Serum creatine (Scr) increased after treatment with time. The elevation of sALB and the reduction of 24hUP in the moderate?dose group were higher than that of low?dose group at 6 months after treatment (P3 mg·kg-1·d-1 subgroup were 76.5% and 53.3%, respectively (P=0.296); In moderate?dose groupthe effective rates of CSA3 mg·kg-1·d-1 subgroup were 89.5%and 84.6%, respectively (P=0.077); there were similar effects in patients treated with different dose CSA in the two groups. About 20.4% of the total patients relapsed when followed up for 18 months (low dose group vs moderate?dose group 9.5% vs 28.6%, P=0.136), which most occurred after prednisone withdrawal or during the reduction of cyclosporine. Renal function decreased in 57.8% patients (low dose group vs moderate?dose group50%vs 65.6%), mainly in the elderly (9/11) and the long course of treatment of CSA. There was no significant difference on adverse reactions between the two groups (P>0.05). Renal function in patients with high Scr or high blood trough concentration of cyclosporine was difficult to fully recover. Conclusions Remission rate is lower in low?dose prednisone combined with cyclosporine than the moderate?dose group in the treatment of IMN for 6 months. The recurrence rate of IMN or the incidence of adverse reactions are similar between the two groups. Induction therapy of IMN with cyclosporin<3 mg·kg-1·d-1 is safe and effective. The incidence of renal function reduction in the elderly is high, and the renal function is difficult to restore in patients with Scr exceeding normal upper limits.