ORAL CYCLOPHOSPHAMIDE VERSUS CHLORAMBUCIL IN THE TREATMENT OF PATIENTS WITH MEMBRANOUS NEPHROPATHY AND RENAL-INSUFFICIENCY

We treated patients with idiopathic membranous nephropathy (iMGN) and renal insufficiency, using: (i) (n=15) monthly cycles of steroids (1 g methyl-prednisolone i.v. on three consecutive days, followed by oral prednisone 0.5 mg/kg/day months 1, 3 and 5) and chlorambucil (0.15 mg/ kg/day months 2, 4 and 6); or (ii) (n=17) oral cyclophosphamide (1.5-2 .0 mg/kg/day for 1 year) and steroids in a comparable dose. The groups were comparable in age, renal function and levels of proteinuria. Dur ing the 6 months preceding treatment, serum creatinine levels increase d from 148+/-50 to 219+/-73 mu mol/l in the chlorambucil group and fro m 164+/-86 to 274+/-126 mu mol/l in the cyclophosphamide group. Median (range) follow-ups were: chlorambucil 38 months (8-71); cyclophospham ide 26 months (5-68) (NS). Renal function improved in both groups, but the improvement was short-lived in the chlorambucil group; 12 months after starting treatment, mean serum creatinine was 6.3 mu mol/l lower in the chlorambucil group and 121 mu mol/l lower in the cyclophospham ide group (p < 0.01). Four chlorambucil-treated patients developed ESR D, and five needed a second course of therapy, whereas only one cyclop hosphamide-treated patient developed ESRD (p < 0.05). Remissions of pr oteinuria occurred more frequently after cyclophosphamide treatment (1 5/17 vs. 5/15; p < 0.01). Side-effects necessitated interruption of tr eatment in six patients on cyclophosphamide and in 11 on chlorambucil (p < 0.05). In our patients, oval cyclophosphamide was better tolerate d than oral chlorambucil. The suggested greater efficacy of the oral c yclophosphamide regimen needs to be ascertained by longer follow-up.