title: Benefit and cost from the long-term use of cyclosporine-A in idiopathic membranous nephropathy.
abstract: OBJECTIVE
  Idiopathic membranous nephropathy (IMN), the most common cause of nephrotic syndrome in adults, is usually treated by cyclosporin A (CsA). Estimation of the effectiveness of long-term use of CsA in the remission and relapse rate of nephrotic syndrome along with histological changes in repeat renal biopsies was the aim of the study.
  
  
  METHODS
  Thirty-two nephrotic patients with well-preserved renal function treated by prednisolone and CsA were studied. A repeat biopsy was performed in 18 patients with remission of nephrotic syndrome, after 24 months of treatment, to estimate the activity of the disease and features of CsA toxicity.
  
  
  RESULTS
  Complete remission of nephrotic syndrome was observed in 18 (56%) and partial remission in 10 patients (31%) after 12 months of treatment (total 87%). Relapses were observed in 39% and 60% of patients with complete and partial remission, respectively, and multiple relapses in 25% of patients, who showed gradual unresponsiveness to CsA and decline of renal function. Progression of stage of the disease and more severe glomerulosclerosis and tubulointerstitial injury were recognized in 55% and 61% of patients respectively. Features of CsA nephrotoxicity were not observed. The severity of histological changes was related to the time elapsed from the first biopsy (r = 0.452, P < 0.05).
  
  
  CONCLUSIONS
  Low doses of CsA with prednisolone induce remission of nephrotic syndrome in most idiopathic membranous nephropathy patients. Although typical features of CsA nephrotoxicity are not observed, significant deterioration of histological lesions occurs with time, even in patients with remission. Long-term use of CsA should be examined with caution.
authors.affiliation: Department of Internal Medicine-Nephrology, University Hospital, Patras, Greece.
authors.forename: Pantelitsa
authors.initials: P
authors.lastname: Kalliakmani
authors.forename: Eleni
authors.initials: E
authors.lastname: Koutroulia
authors.forename: Florentia
authors.initials: F
authors.lastname: Sotsiou
authors.forename: John G
authors.initials: JG
authors.lastname: Vlachojannis
authors.forename: Dimitrios S
authors.initials: DS
authors.lastname: Goumenos
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D016572:Cyclosporine / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000188:drug therapy* / Q000473:pathology; D011239:Prednisolone / Q000627:therapeutic use; D012008:Recurrence; D012074:Remission Induction; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D011239:Prednisolone