| Title | Low-dose cyclosporine in treatment of membranous nephropathy with nephrotic syndrome: effectiveness and renal safety |
| Authors | Yu, Xiaojuan Ruan, Lin Qu, Zhen Cui, Zhao Zhang, Yimiao Wang, Xin Meng, Liqiang Liu, Xiaojing Wang, Fang Zhang, Ying Liu, Gang Yang, Li |
| Affiliation | Peking Univ, Dept Med, Renal Div, Hosp 1, Beijing 100034, Peoples R China. Peking Univ, Inst Nephrol, Beijing, Peoples R China. Minist Hlth China, Key Lab Renal Dis, Beijing, Peoples R China. Minist Educ China, Key Lab CKD Prevent & Treatment, Beijing, Peoples R China. First Municipal Hosp, Dept Med, Renal Div, Shijiazhuang, Hebei, Peoples R China. Peking Univ, Dept Med, Renal Div, Hosp 1, Beijing 100034, Peoples R China. Liu, G Yang, L (reprint author), Peking Univ, Inst Nephrol, Beijing, Peoples R China. |
| Keywords | Cyclosporine membranous nephropathy nephrotic syndrome nephrotoxicity renal injury GLOMERULAR-FILTRATION-RATE CONTROLLED-TRIAL FOLLOW-UP ADULTS POPULATION REMISSION EQUATION THERAPY |
| Issue Date | 2017 |
| Publisher | RENAL FAILURE |
| Citation | RENAL FAILURE. 2017, 39(1), 688-697. |
| Abstract | Background: To observe effectiveness and renal safety of long-term low-dose cyclosporine in idiopathic membranous nephropathy (IMN).& para;& para;Methods: Sixty-eight patients were enrolled in this prospective cohort study. Renal endpoint was defined as a decrease in eGFR >= 50% from baseline and a development of eGFR <= 60 ml/min/1.73m(2).& para;& para;Results: A cyclosporine dose of 2.0 +/- 0.5 mg/kg/d and a prednisone of 0.3 +/- 0.2 mg/kg/d were prescribed. The duration of cyclosporine treatment was 27 (3-80) months. The overall remission rate was 91% with a relapse rate of 42%. Fourteen patients had cyclosporine-related acute renal injury (CsA-ARI) within the first three months, and 16 patients had cyclosporine related chronic renal injury (CsA-CRI) within the first year. At the end of follow-up (50 +/- 18 months), 16 patients (24%) reached renal endpoint. Presence of intimal fibrosis of small artery and higher time-averaged proteinuria were identified as independent risk factors for renal endpoint. RAS inhibition treatment decreased the risk of poor renal outcome. Patients in CsA-ARI group had the highest proteinuria at the third month, the highest time-average proteinuria and the highest proportion of cases reaching renal endpoint. Patients with CsA-CRI were of the oldest age and with the lowest baseline eGFR.& para;& para;Conclusions: Low-dose cyclosporine is effective in treating IMN. CsA-ARI and no response in proteinuria during the first three months of cyclosporine treatment had the lowest benefit/risk ratio, and these patients should be switched to non-calcineurin-inhibitor based regimen. Patients of older age, with lower baseline eGFR, or having intimal sclerosis of small artery, are more likely to develop progressive renal dysfunction. |
| URI | http://hdl.handle.net/20.500.11897/501095 |
| ISSN | 0886-022X |
| DOI | 10.1080/0886022X.2017.1373130 |
| Indexed | SCI(E) PubMed Medline |
| Appears in Collections: | 第一医院 |
