title: Immunosuppressive therapy with cyclophosphamide and prednisolone in severe idiopathic membranous nephropathy.
abstract: In idiopathic membranous nephropathy (IMN) immunosuppressive therapy should be reserved for patients with potential risk factors at baseline or who show a progressive course. Cyclophosphamide pulse therapy (CPT) in IMN is not yet widely tested. We carried out a trial of CPT combined with conventional treatment in a group of patients with IMN at a greater risk. The study group consisted of 36 nephrotic adult IMN patients (M, 26; F, 10) with various combinations of risk factors. Mean proteinuria was 11.3 g/day, 47% patients were hypertensive, 78% had tubular changes, and 36% had focal glomerulosclerosis. They were treated with CPT and/or conventional low-dose cyclophosphamide and prednisolone. Median duration of immunosuppression was 14 months and median total cumulative dose of cyclophosphamide 172 mg/kg body weight. At 6 months (6m) remission was achieved in 44% cases and at the 36th month in 73%. None of the patients developed moderate or severe renal failure. Side-effects were minimal. Multivariate analysis of baseline data and the changing course of the disease during therapy showed that tubular changes (P = 0.0025), creatinine clearance at baseline (P = 0.04) and at 6m (P = 0.02), and proteinuria at 6m (P < 0.0001) significantly influenced the therapeutic effect. We conclude that cyclophosphamide (including pulse) and prednisolone can bring significant remission and maintain renal function in IMN with potential risk factors.
authors.affiliation: 1st Nephrology Clinic, Christo Michailov 8, Medical Academy Sofia, Bulgaria.
authors.forename: M G
authors.initials: MG
authors.lastname: Kibriya
authors.forename: I
authors.initials: I
authors.lastname: Tishkov
authors.forename: D
authors.initials: D
authors.lastname: Nikolov
mesh_terms: D000328:Adult; D003520:Cyclophosphamide / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007668:Kidney / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011239:Prednisolone / Q000008:administration & dosage*; D011379:Prognosis; D011507:Proteinuria / Q000188:drug therapy; D012307:Risk Factors
chemical_list: D003520:Cyclophosphamide; D011239:Prednisolone