IMMUNOSUPPRESSIVE THERAPY WITH CYCLOPHOSPHAMIDE AND PREDNISOLONE IN SEVERE IDIOPATHIC MEMBRANOUS NEPHROPATHY

In idiopathic membranous nephropathy (IMN) immunosuppressive therapy s hould be reserved for patients with potential risk factors at baseline or who show a progressive course. Cyclophosphamide pulse therapy (CPT ) in IMN is not yet widely tested. We carried out a trial of CPT combi ned with conventional treatment in a group of patients with IMN at a g reater risk. The study group consisted of 36 nephrotic adult IMN patie nts (M, 26; F, 10) with various combinations of risk factors. Mean pro teinuria was 11.3 g/day, 47% patients were hypertensive, 78% had tubul ar changes, and 36% had focal glomerulosclerosis. They were treated wi th CPT and/or conventional low-dose cyclophosphamide and prednisolone. Median duration of immunosuppression was 14 months and median total c umulative dose of cyclophosphamide 172 mg/kg body weight. At 6 months (6m) remission was achieved in 44% cases and at the 36th month in 73%. None of the patients developed moderate or severe renal failure. Side -effects were minimal. Multivariate analysis of baseline data and the changing course of the disease during therapy showed that tubular chan ges (P= 0.0025), creatinine clearance at baseline (P = 0.04) and at 6m (P = 0.02), and proteinuria at 6m (P<0.0001) significantly influenced the therapeutic effect. We conclude that cyclophosphamide (including pulse) and prednisolone can bring significant remission and maintain r enal function in IMN with potential risk factors.