Low-dose cyclosporine treatment in Chinese nephrotic patients with idiopathic membranous nephropathy: An uncontrolled study with prospective follow-up.
BACKGROUND
The optimal dose of cyclosporine A (CsA) in treatment of nephrotic proteinuria in idiopathic membranous nephropathy (IMN) remains inconclusive. We evaluated the efficacy and safety of low-dose CsA combined with low-dose prednisone as induction therapy for Chinese nephrotic patients with IMN.


METHODS
We conducted a prospective observational cohort study in 18 patients with IMN and nephrotic proteinuria. Twelve patients were refractory to other immunosuppressive therapies. The initial dose of CsA was 1 to 1.5 mg/kg/d combined with 0.15 to 0.50 mg/kg/d prednisone. The dose of CsA was adjusted monthly by 20% to 30% according to efficacy and the 12-hour trough blood concentration (C0) of CsA around 100 ng/mL for 6 months; when proteinuria was <1 g/d, CsA was tapered gradually to a dose of 0.6 to 1 mg/kg/d.


RESULTS
Two patients discontinued CsA because of refractory hypertension. The remaining 16 patients had been followed up for 44 +/- 15 weeks. Remission was observed in 11 patients (68.8%: complete remission, 6 and partial remission, 5). The effective dose of CsA for remission was 2.1 +/- 0.4 (1.5-2.5) mg/kg/d, and the mean C0 of CsA was 92.5 +/- 23.5 (58-124) ng/mL. All the 16 patients experienced well-controlled adverse effects, including hypertension (n = 12), hyperuricemia (n = 12), increase of serum creatinine (n = 2), etc.


CONCLUSIONS
Low-dose CsA combined with low-dose prednisone was effective and safe as induction therapy in majority of Chinese nephrotic patients with IMN, including those refractory to other immunosuppressive regimens.
Li
Jun
J
Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Beijing, China.
Zhang
Yi-Miao
YM
Qu
Zhen
Z
Zhao
Ming-Hui
MH
Liu
Gang
G
D000293:Adolescent; D000328:Adult; D016572:Cyclosporine / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D015433:Glomerulonephritis, Membranous / Q000188:drug therapy*; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D011446:Prospective Studies; D055815:Young Adult
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D011241:Prednisone