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

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2009-10, Vol.24 (10), p.3082-3088
• Main Authors: Eriguchi, Masahiro, Oka, Hideaki, Mizobuchi, Takeshi, Kamimura, Taro, Sugawara, Koji, Harada, Atsumi
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cyclophosphamide - administration & dosage; Emergency and intensive care: renal failure. Dialysis management; Female; Glomerulonephritis; Glomerulonephritis, Membranous - drug therapy; Glucocorticoids - administration & dosage; Humans; idiopathic membranous nephropathy; Immunosuppressive Agents - administration & dosage; Intensive care medicine; Japan; Japanese patients; low-dose cyclophosphamide; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; nephrotic syndrome; Prednisolone - administration & dosage; Prospective Studies; renal prognosis; Time Factors; Young Adult
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfp251

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 mg/day for the first 3 months and 25 mg/day for the next 3 months) and prednisolone (30 mg/day 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 1.5 mg/dL) 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.