Stepwise Treatment Using Corticosteroids Alone and in Combination with Cyclosporine in Korean Patients with Idiopathic Membranous Nephropathy
Yonsei Medical Journal
; : 973-982, 2013.
Article
em En
| WPRIM
| ID: wpr-99037
Biblioteca responsável:
WPRO
ABSTRACT
PURPOSE:
We undertook an observational study to investigate the effects of immunosuppressive treatment on proteinuria and renal function in 179 Korean idiopathic membranous nephropathy patients with nephrotic syndrome. MATERIALS ANDMETHODS:
The primary outcome was regarded as the first appearance of remission and the secondary outcomes as a decline in estimated glomerular filtration rate (eGFR) >50% or initiation of dialysis, and all-cause mortality. Seventy-two (40.2%) and 50 (27.9%) patients were treated with corticosteroids alone (C) and corticosteroids plus cyclosporine (C+C), respectively, whereas 57 (31.8%) did not receive immunosuppressants (NTx). Cyclosporine was added if there was no reduction in proteinuria of >50% from baseline by corticosteroids alone within 3 months.RESULTS:
There were no differences in baseline renal function and the amount of proteinuria among the three groups. Overall, complete remission (CR) was achieved in 88 (72.1%) patients by immunosuppressants. In a multivariate analysis adjusted for covariates associated with adverse renal outcome, the probability of reaching CR was significantly higher in the C [hazard ratio (HR), 4.09; p<0.001] and C+C groups (HR, 2.57; p=0.003) than in the NTx group. Kaplan-Meier analysis revealed that 5-year CR rates of C, C+C, and NTx groups were 88.5%, 86.2%, and 56.7% (p<0.001). Ten-year event-free rates for the secondary endpoints in these three groups were 91.7%, 79.9%, and 57.2% (p=0.01).CONCLUSION:
Immunosuppressive treatment was effective in inducing remission and preserving renal function in these patients. Therefore, stepwise treatment using corticosteroids alone and in combination with cyclosporine is warranted in these patients.Palavras-chave
Texto completo:
1
Base de dados:
WPRIM
Assunto principal:
Proteinúria
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Esquema de Medicação
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Glomerulonefrite Membranosa
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Resultado do Tratamento
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Ciclosporina
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Corticosteroides
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Estimativa de Kaplan-Meier
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Taxa de Filtração Glomerular
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Imunossupressores
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Rim
Tipo de estudo:
Observational_studies
Limite:
Adult
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Aged
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Female
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Humans
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Male
Idioma:
En
Revista:
Yonsei Medical Journal
Ano de publicação:
2013
Tipo de documento:
Article