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Low-dose cyclosporine in treatment of membranous nephropathy with nephrotic syndrome: effectiveness and renal safety

机译:小剂量环孢霉素治疗合并肾病综合征的膜性肾病的疗效和肾脏安全性

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>Background: To observe effectiveness and renal safety of long-term low-dose cyclosporine in idiopathic membranous nephropathy (IMN).>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/1.73m2.>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.>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.
机译:>背景:观察长期低剂量环孢菌素在特发性膜性肾病(IMN)中的有效性和肾脏安全性。>方法:该研究纳入了68位患者研究。肾终点定义为eGFR从基线下降≥50%,eGFR≤60ml / min / 1.73m 2 。>结果:环孢素剂量为2.0开处方的剂量为±0.5±mg / kg / d,泼尼松为0.3±0.2μg/ kg / d。环孢素治疗的持续时间为27(3–80)个月。总体缓解率为91%,复发率为42%。在头三个月内有14例患者发生了环孢素相关的急性肾损伤(CsA-ARI),在头一年内有16例患者发生了环孢素相关的慢性肾损伤(CsA-CRI)。在随访结束时(50±18个月),有16例患者(占24%)达到了肾脏终点。小动脉内膜纤维化的存在和较高的时间平均蛋白尿被确定为肾终点的独立危险因素。 RAS抑制治疗降低了肾预后不良的风险。 CsA-ARI组的患者在第三个月的蛋白尿水平最高,时间平均蛋白尿的比例最高,到达肾脏终点的病例比例最高。 CsA-CRI患者年龄最大,基线eGFR最低。>结论:低剂量环孢霉素可有效治疗IMN。 CsA-ARI和环孢素治疗的前三个月对蛋白尿无反应的获益/风险比最低,因此这些患者应改用非钙调神经磷酸酶抑制剂治疗。基线eGFR较低或患有小动脉内膜硬化的老年患者更有可能发展为进行性肾功能不全。

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