Efficacy and safety of low-dose chlorambucil in nephrotic patients with idiopathic membranous nephropathy.
OBJECTIVE
This observational study aimed to evaluate the results of treatment with low-dose chlorambucil in combination with corticosteroids in patients with idiopathic membranous nephropathy (iMGN) and nephrotic syndrome.


METHODS
Thirty-two patients with nephrotic syndrome and biopsy-proven iMGN were included in the study. At presentation, 9 patients were found to be in stage 1, 13 patients in stage 2 and 10 patients in stage 3 chronic kidney disease. In all patients, i.v. methylprednisolone pulses (500 mg/day for 3 days) were administered, followed by oral prednisone at an initial dose of 1 mg/kg per day, tapered gradually after 8 weeks to the maintenance dose of 5 mg/day after 6 months, and chlorambucil 2 mg twice daily for 6 months.


RESULTS
Complete remission of nephrotic syndrome was obtained in 14 patients (47.3%) and partial remission in 16 patients (50%). Two patients relapsed after 1 year of treatment. We did not record any severe side effects in treated patients, except glucose intolerance in 4 subjects on high corticosteroid doses.


CONCLUSIONS
Immunosuppressive treatment with corticosteroids and low-dose chlorambucil seems to be effective and well tolerated in nephrotic patients with iMGN.
Department of Nephrology, Transplantology and Internal Medicine, University of Medical Sciences, Poznań, Poland. ilonaidasiak@poczta.onet.pl
Ilona
I
Idasiak-Piechocka
Andrzej
A
Oko
Katarzyna
K
Łochyńska-Bielecka
Beata
B
Skrobańska
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002699:Chlorambucil / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D015433:Glomerulonephritis, Membranous / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000473:pathology; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D011241:Prednisone / Q000627:therapeutic use; D011507:Proteinuria / Q000188:drug therapy; D012709:Serum Albumin / Q000378:metabolism; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D018906:Antineoplastic Agents, Alkylating; D012709:Serum Albumin; D002699:Chlorambucil; D011241:Prednisone; D008775:Methylprednisolone