Effects of steroids-free immunosuppressive treatment for membranous nephropathy combining with type 2 diabetes mellitus
10.3760/cma.j.issn.1001-7097.2019.12.003
- VernacularTitle: 联合或不联合糖皮质激素的免疫抑制方案治疗膜性肾病合并2型糖尿病的疗效比较
- Author:
Minqiao ZHANG
1
,
2
,
3
;
Yilin ZHU
;
Junmin GUO
;
Kedan CAI
;
Jianghua CHEN
;
Fei HAN
Author Information
1. Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University
2. Institute of Nephrology, Zhejiang University
3. Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou 310003, China (Zhang Minqiao is working at Department of Nephrology, the First People's Hospital of Xiangshan, Ningbo 315700, China)
- Publication Type:Clinical Trail
- Keywords:
Diabetes mellitus, type 2;
Glomerulonephritis, membranous;
Glucocorticoids;
Immunosuppressive agents
- From:
Chinese Journal of Nephrology
2019;35(12):893-898
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the efficacy and safety of steroids-free immunosuppressive therapy including tacrolimus, cyclosporin A, tripterygium glycosides or intravenous cyclophosphamide in membranous nephropathy (MN) patients combined with type 2 diabetes mellitus (T2DM).
Methods:This study was a retrospective analysis of patients with T2DM complicated with biopsy proved MN in the First Affiliated Hospital, College of Medicine, Zhejiang University from January 2009 to January 2017. The patients were divided into steroids-free group and control group. The patients in steroids-free group were treated with one or two immunosuppressive agents except glucocorticoids. The patients in control group were treated with glucocorticoid combining with immunosuppressive agents.
Results:A total of 64 patients were enrolled in this study. There were 26 cases in steroids-free group and 38 cases in control group. The total remission rate was 69.24% in steroids-free group and 73.68% in control group at 12 months. In a median follow up of 33(12-106) months, two patients in control group entered hemodialysis and one of them died after 1 year of dialysis. One patient in steroids-free group died of accidental death and no patient entered dialysis. All patients in control group had elevated blood glucose level, whereas only 5 patients in steroids-free group had elevated blood glucose and all these 5 patients used tacrolimus.
Conclusion:Immunosuppressive regimen without glucocorticoid treatment can reduce side effects on blood glucose level in MN patients with type 2 diabetes, with a certain rate of treatment response.
