Triple therapy with single daily dose of cyclosporine in Japanese patients with idiopathic membranous nephropathy.
Triple therapy with single daily dose of cyclosporine in Japanese patients with idiopathic membranous nephropathy.
复制标题
日本特发性膜性肾病患者每日单剂环孢素三联疗法。
DOI：
10.2169/internalmedicine.50.5606
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发表时间：
2011
影响因子：
1.2
通讯作者：
T. Nakao
中科院分区：
文献类型：
--
作者：
H. Matsumoto;Y. Nagaoka;T. Okada;Toshikazu Wada;Asako Gondo;S. Esaki;Ami Hayashi;Yoshitaka Miyaoka;T. Nakao
目的
特发性膜性肾病（IMN）患者的最佳治疗方法仍存在争议。在这项研究中，我们评估了单次每日剂量环孢素（CsA）联合低剂量泼尼松龙（PSL）和血管紧张素II受体阻滞剂（ARB）治疗IMN患者的疗效。
方法
我们研究了13例经活检诊断为IMN的肾病患者（8例男性，5例女性）。CsA初始单次每日剂量为2 mg/kg，但不超过150 mg，持续12个月，每2个月减少25 mg。初始剂量为0.5 mg/kg PSL，每日两次，持续2个月，并逐渐减量。所有患者均接受ARB治疗，整个研究期间使用相同剂量。随访6 ~ 66个月。
结果
9例患者在6.7±2.9个月时获得完全缓解，其余患者获得不完全缓解。在32.7±20.0个月的随访期后，他们的血清肌酐和估计的肾小球滤过率值与基线水平相似。完成疗程的9例患者均未复发。此外，没有需要停止这种三联疗法的不良反应。
结论
单次每日剂量的CsA联合低剂量的PSL和ARB治疗IMN新发肾病综合征患者，诱导了肾病综合征的高缓解率，复发率低，不良反应的风险低。三联疗法和前瞻性随访显示了作为IMN患者治疗方法的潜力。
OBJECTIVE
The optimal therapeutic approach to patients with idiopathic membranous nephropathy (IMN) remains controversial. In this study, we assessed the efficacy of single daily dose cyclosporine (CsA) combined with low-dose prednisolone (PSL) and an angiotensin II receptor blocker (ARB) in patients with IMN.
METHODS
We studied 13 nephrotic patients (8 men, 5 women) with IMN diagnosed on biopsy. An initial single daily dose of 2 mg/kg, but not exceeding 150 mg, CsA was given for 12 months, tapered by a 25 mg reduction every 2 months. An initial twice-daily dose of 0.5 mg/kg PSL was given for 2 months and was also tapered. An ARB was given to all patients and the same dosage was used throughout the study. Patients were followed up for 6 to 66 months.
RESULTS
Nine patients achieved complete remission at 6.7±2.9 months, and incomplete remission was obtained in the remaining patients. After a follow-up period of 32.7±20.0 months, their serum creatinine and estimated glomerular filtration rate values were similar to baseline levels. The 9 patients who completed the treatment course have not relapsed. Moreover, there were no adverse effects requiring discontinuation of this triple therapy.
CONCLUSION
A single daily dose of CsA combined with a low dose of PSL and an ARB in new-onset nephrotic patients with IMN induced a high remission rate of nephrotic syndrome, with a low incidence of relapse and a low risk of adverse effects. The triple therapy and prospective follow-up shows potential as a treatment approach for patients with IMN.