title: Infusion of autologous bone marrow mononuclear cells leads to transient reduction in proteinuria in treatment refractory patients with Idiopathic membranous nephropathy.
abstract: BACKGROUND
  The current treatment options for idiopathic membranous nephropathy (IMN) carry significant toxicity. In this prospective, observational pilot study, we used single time infusion of bone marrow derived autologous mononuclear cells (MNCs) in adult patients with treatment refractory IMN.
  
  
  METHODS
  Twelve patients of biopsy proven IMN who had failed a cyclical 6-month regimen of steroid and cyclophosphamide were enrolled in the study. Bone-marrow was harvested from the iliac crest and underwent processing to isolate MNCs. Cells were counted and subjected to viability testing before being infused through a peripheral vein on the same day. After the infusion, subjects were followed up monthly for the next six months. Supportive treatment including angiotensin antagonists and statins was continued throughout the study period.
  
  
  RESULTS
  The proteinuria, serum albumin and creatinine values at entry were 2.97 ± 0.6 gm/1.73 m2/d, 2.27 ± 1.1 gm/l and 0.9 ± 0.8 mg/dl respectively. There was a reduction in proteinuria (p < 0.0001), and increase in serum albumin (p = 0.001) at 1 month, with 64% of the subjects showing >50% reduction in proteinuria. However, the response was ill sustained. At 6 months, only 2 patients had >50% reduction. Serum creatinine remained stable throughout the study period. No infusion related side effects were noted.
  
  
  CONCLUSIONS
  Autologous mononuclear cell infusion leads to transitory reduction in proteinuria and improvement in serum albumin in treatment refractory IMN. This effect, however, is transient. Whether this can be overcome by repeated infusion of cultured mesenchymal cells needs to be investigated.
authors.affiliation: Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. vjha@pginephro.org.
authors.forename: Upal
authors.initials: U
authors.lastname: Sengupta
authors.forename: Vinod
authors.initials: V
authors.lastname: Kumar
authors.forename: Ashok K
authors.initials: AK
authors.lastname: Yadav
authors.forename: Neelam
authors.initials: N
authors.lastname: Marwaha
authors.forename: Harbir S
authors.initials: HS
authors.lastname: Kohli
authors.forename: Vinay
authors.initials: V
authors.lastname: Sakhuja
authors.forename: Vivekanand
authors.initials: V
authors.lastname: Jha
mesh_terms: D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000379:methods*; D002908:Chronic Disease; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000150:complications*; D006801:Humans; D008297:Male; D045164:Mesenchymal Stem Cell Transplantation / Q000379:methods*; D008875:Middle Aged; D010865:Pilot Projects; D011507:Proteinuria / Q000209:etiology* / Q000517:prevention & control*; D016896:Treatment Outcome; D055815:Young Adult