期刊
BIOMEDICINE & PHARMACOTHERAPY
卷 65, 期 2, 页码 105-110出版社
ELSEVIER FRANCE-EDITIONS SCIENTIFIQUES MEDICALES ELSEVIER
DOI: 10.1016/j.biopha.2010.10.009
关键词
Azathioprine; Cyclosporine; Idiopathic membranous nephropathy
资金
- Ministry of Science and Technology of the Republic of Serbia [145043]
There is no consensus regarding themodality of therapy for idiopathic membranous nephropathy (IMN), especially for patients who did not react to treatment with cytotoxic drugs. This study followed prospectively for 3-year IMN patients who did not react to Ponticelli protocol comparing effects of 2-year course of cyclosporine (CsA) with azathioprine (Aza) treatment both with small doses of prednisolone. Twenty-three patients were randomly assigned to receive either cyclosporine at 3 mg/kg per day (10 patients) or azathioprine at 1.5 to 2 mg/kg (13 patients). Both groups were comparable regarding age, sex and renal function, except for proteinuria, which was significantly greater in CsA group (P = 0.003). Similar rate of remission of nephrotic syndrome (NS) have been noted at the end of treatment (80% CsA versus 93% Aza). During last year, follow-up relapses of NS were more frequent in Aza group (5 versus 1). A fall in proteinuria was recorded in both groups during treatment, but it rose significantly in Aza group (1.5 g/day versus 3.1 g/day, P = 0.04) and remained unchanged in CsA group (3.9 g/day versus 4.1 g/day) after treatment cessation. Renal function deteriorated in Aza group (sCr 120.5 versus 269.8 mu mol/L; P < 0.01) and was stable in CsA group. In conclusion, CsA and steroids may be a very important option in the management of high-risk IMN patients. Long-term treatment is necessary for achievement of full therapeutic effect. Treatment with Aza did not have long-term benefits particularly regarding renal function preservation. (C) 2010 Elsevier Masson SAS. All rights reserved.
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