Stepwise Treatment Using Corticosteroids Alone and in Combination with Cyclosporine in Korean Patients with Idiopathic Membranous Nephropathy

作者：Shin Dong Ho; Lee Mi Jung; Oh Hyung Jung; Koo Hyang Mo; Doh Fa Mee; Kim Hyoung Rae; Han Jae Hyun; Park Jung Tak; Han Seung Hyeok; Choi Kyu Hun; Yoo Tae Hyun; Kang Shin Wook^*

来源：Yonsei Medical Journal, 2013, 54(4): 973-982.

DOI：10.3349/ymj.2013.54.4.973

• Corticosteroids
• cyclosporine
• idiopathic membranous nephropathy
• nephrotic syndrome
• remission

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) %26gt;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 %26gt;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 (RR), 4.09; p%26lt;0.001] and C+C groups (RR, 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%26lt;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.

• 出版日期2013-7-1