Treatment of idiopathic membranous nephropathy with the combination of steroids, tacrolimus and mycophenolate mofetil:: results of a pilot study

Background. Membranous nephropathy is a common cause of nephrotic syndrome (NS) in adults. Its treatment is still under debate. Methods. We report our experience in a pilot study using initially low doses of steroids and tacrolimus (Tac). After 3 months of treatment, mycophenolate mofetil (MMF) was added if the proteinuria was higher than 1g/day. Results. In accordance with this standard, 21 patients entered the study. A proteinuria level lower than 1g/day was reached at month 3 of therapy with steroids and Tac in 11 patients. These patients continued this treatment for 12 months. MMF was added in nine cases after the third month and triple therapy was maintained for 12 more months. Two patients were withdrawn because of side effects. At the end of the treatment, remission of the NS was present in 15 out of all the patients (71.4). Remission of the NS was complete in eight (53.3) patients and partial in seven (46.7) others. The remaining four patients did not respond. There were no significant changes in renal function. At a mean time of 23.1 months after treatment was discontinued, 11 (73.3) patients had relapsed. Conclusions. In this trial, treatment with tacrolimus showed a good efficacy but a high relapse rate when it was discontinued.