[The clinical efficacy and safety of modified Ponticelli regimen for treatment of idiopathic membranous nephropathy].

OBJECTIVE: To explore the clinical efficacy and safety of modified Ponticelli regimen in treating patients with idiopathic membranous nephropathy(IMN). METHODS: A retrospective analysis was performed in 90 patients with IMN (type Ⅰ/Ⅱ, 79/11 respectively) diagnosed by clinical data and renal biopsy. The patients were divided into modified Ponticelli group (n=23), steroid plus cyclophosphamide(CTX) (CTX group, n=39) and steroid plus cyclosporine A(CsA) (CsA group, n=28) according to the treatment. Liver function, renal function, serum lipid, proteinuria were recorded before and after treatment. Efficacy and adverse reactions were evaluated in three groups. RESULTS: (1)In all three groups, the quantity of proteinuria after treatment for 3 months [(3.33 ± 1.53) g/d, (4.70 ± 2.97) g/d, (3.92 ± 2.57) g/d], 6 months [(1.60 ± 1.10) g/d, (2.34 ± 1.61) g/d, (2.25 ± 1.78) g/d] was significantly decreased compared with baseline level[(7.26 ± 2.06) g/d, (7.50 ± 2.55) g/d, (7.54 ± 2.70) g/d; P<0.05]. Serum albumin levels at 3 months[(31.42 ± 3.86) g/d, (30.59 ± 5.79) g/d, (30.90 ± 7.87) g/d], 6 months [(36.25 ± 4.20) g/d, (34.70 ± 6.70) g/d, (35.36 ± 8.29) g/d] were significantly increased compared with baseline levels [(24.13 ± 2.61) g/d, (23.98 ± 3.79) g/d, (22.94 ± 4.57) g/d; P<0.05], whereas serum creatinine at 3 and 6 months had no significant changes (P>0.05). (2)After treatment for 3 months, partial remission rates in modified Ponticelli group, CTX group and CsA group were 39.1%, 35.9%, 35.7% respectively and complete remission rates were 8.7%, 5.1%, 10.7%, which were not statistically significant in all three groups (P>0.05). At 6 months, partial remission rates in three groups were 56.5%, 41.0%, 42.9% respectively and complete remission rates were 21.7%, 20.5%, 28.6%, which did not suggested significant difference in all three groups either (P>0.05). (3)In modified Ponticelli group, steroid diabetes, impaired liver dysfunction, infections and gastrointestinal adverse events occurred in 1, 1, 2 and 2 patients, respectively. In CTX group, steroid diabetes, infections and gastrointestinal adverse events occurred in 5, 8 and 2 patients, respectively. In CsA group, steroid diabetes and infections occurred in 1 and 3 patients, respectively. CONCLUSION: Modified Ponticelli regimen to treat patients with IMN has a trend of better outcome than classic CTX regimen. The efficacy is not inferior to CsA regimen with fewer side effects.