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

Content Provider	Taylor & Francis Online
Author	Cui, Zhao Wang, Xin Liu, Xiaojing Yu, Xiaojuan Qu, Zhen Yang, Li Zhang, Ying Ruan, Lin Zhang, Yimiao Wang, Fang Liu, Gang Meng, Liqiang
Abstract	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.
Starting Page	688
Ending Page	697
Page Count	10
File Format	PDF HTM / HTML
ISSN	0886022X 15256049
DOI	10.1080/0886022X.2017.1373130
Journal	Renal Failure
Volume Number	39
Issue Number	1
Language	English
Publisher	Taylor & Francis
Publisher Date	2017-09-08
Access Restriction	Open
Subject Keyword	Cyclosporine Membranous nephropathy Nephrotic syndrome Nephrotoxicity Renal injury
Content Type	Text
Resource Type	Article
Subject	Critical Care and Intensive Care Medicine Nephrology

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