Long-term outcomes of idiopathic membranous nephropathy in Japanese patients treated with low-dose cyclophosphamide and prednisolone

Masahiro Eriguchi, Hideaki Oka, Takeshi Mizobuchi, Taro Kamimura, Koji Sugawara, Atsumi Harada

研究成果: Contribution to journalArticle査読

22 被引用数 (Scopus)

抄録

Background. Treatment with cyclophosphamide and steroids for idiopathic membranous nephropathy (IMN) is effective in Caucasian patients, but the cumulative cyclophosphamide dosage exceeds 10 g and includes steroid pulse therapy. Adverse effects and difficulties with repeating treatment are major limitations. We studied the long-term outcomes of low-dose cyclophosphamide and prednisolone therapy in Japanese patients, who were thought to have relatively benign IMN compared with Caucasian patients.Methods. This is a prospective cohort study of 103 consecutive Japanese patients with IMN and nephrotic syndrome. Patients were treated with cyclophosphamide (50 mgday for the first 3 months and 25 mgday for the next 3 months) and prednisolone (30 mgday for the first week and the dosage was gradually tapered to withdraw by 2 years). Additional therapies were allowed for initial treatment failure or relapse.Results. With a mean observation period of 8.5 years, 90 patients (87.4) achieved proteinuria of <1 gday and 78 (75.7) achieved complete remission. A total of 27 patients did not respond to initial treatment and 30 patients had relapses after remission. Of these patients, 39 received additional therapies. At the last observation, 12 patients had developed renal insufficiency (S-Cr >1.5 mgdL) but only 2 patients had reached renal death. Multivariate analysis revealed that the duration without remission was the strongest risk factor for renal prognosis. There were 14 deaths, and 8 patients developed cancers during the observation period.Conclusion. Treating nephrotic IMN in Japanese patients with low-dose cyclophosphamide and prednisolone is beneficial for long-term renal prognosis with relatively few adverse effects.

本文言語英語
ページ(範囲)3082-3088
ページ数7
ジャーナルNephrology Dialysis Transplantation
24
10
DOI
出版ステータス出版済み - 10 2009
外部発表はい

All Science Journal Classification (ASJC) codes

  • 腎臓病学
  • 移植

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