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- Title
Stepwise Treatment Using Corticosteroids Alone and in Combination with Cyclosporine in Korean Patients with Idiopathic Membranous Nephropathy.
- Authors
Dong Ho Shin; 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
- 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.
- Subjects
CORTICOSTEROIDS; CYCLOSPORINE; CROUP; SCIENTIFIC observation; GLOMERULAR filtration rate; NEPHROTIC syndrome
- Publication
Yonsei Medical Journal, 2013, Vol 54, Issue 4, p973
- ISSN
0513-5796
- Publication type
Article
- DOI
10.3349/ymj.2013.54.4.973