Stepwise Treatment Using Corticosteroids Alone and in Combination with Cyclosporine in Korean Patients with Idiopathic Membranous Nephropathy.
10.3349/ymj.2013.54.4.973
- Author:
Dong Ho SHIN
1
;
Mi Jung LEE
;
Hyung Jung OH
;
Hyang Mo KOO
;
Fa Mee DOH
;
Hyoung Rae KIM
;
Jae Hyun HAN
;
Jung Tak PARK
;
Seung Hyeok HAN
;
Kyu Hun CHOI
;
Tae Hyun YOO
;
Shin Wook KANG
Author Information
1. Department of Internal Medicine, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea.
- Publication Type:Original Article ; Observational Study ; Research Support, Non-U.S. Gov't
- Keywords:
Corticosteroids;
cyclosporine;
idiopathic membranous nephropathy;
nephrotic syndrome;
remission
- MeSH:
Adrenal Cortex Hormones/adverse effects/*therapeutic use;
Adult;
Aged;
Cyclosporine/adverse effects/*therapeutic use;
Drug Administration Schedule;
Female;
Glomerular Filtration Rate/drug effects;
Glomerulonephritis, Membranous/*drug therapy/mortality;
Humans;
Immunosuppressive Agents/adverse effects/*therapeutic use;
Kaplan-Meier Estimate;
Kidney/drug effects/physiology;
Male;
Middle Aged;
Proteinuria/chemically induced;
Treatment Outcome
- From:Yonsei Medical Journal
2013;54(4):973-982
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: We undertook an observational study to investigate the effects of immunosuppressive treatment on proteinuria and renal function in 179 Korean idiopathic membranous nephropathy patients with nephrotic syndrome. MATERIALS AND METHODS: The primary outcome was regarded as the first appearance of remission and the secondary outcomes as a decline in estimated glomerular filtration rate (eGFR) >50% or initiation of dialysis, and all-cause mortality. Seventy-two (40.2%) and 50 (27.9%) patients were treated with corticosteroids alone (C) and corticosteroids plus cyclosporine (C+C), respectively, whereas 57 (31.8%) did not receive immunosuppressants (NTx). Cyclosporine was added if there was no reduction in proteinuria of >50% from baseline by corticosteroids alone within 3 months. RESULTS: There were no differences in baseline renal function and the amount of proteinuria among the three groups. Overall, complete remission (CR) was achieved in 88 (72.1%) patients by immunosuppressants. In a multivariate analysis adjusted for covariates associated with adverse renal outcome, the probability of reaching CR was significantly higher in the C [hazard ratio (HR), 4.09; p<0.001] and C+C groups (HR, 2.57; p=0.003) than in the NTx group. Kaplan-Meier analysis revealed that 5-year CR rates of C, C+C, and NTx groups were 88.5%, 86.2%, and 56.7% (p<0.001). Ten-year event-free rates for the secondary endpoints in these three groups were 91.7%, 79.9%, and 57.2% (p=0.01). CONCLUSION: Immunosuppressive treatment was effective in inducing remission and preserving renal function in these patients. Therefore, stepwise treatment using corticosteroids alone and in combination with cyclosporine is warranted in these patients.
