Treatment of idiopathic membranous nephropathy with the combination of steroids, tacrolimus and mycophenolate mofetil:: results of a pilot study
Treatment of idiopathic membranous nephropathy with the combination of steroids, tacrolimus and mycophenolate mofetil:: results of a pilot study
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DOI：
10.1093/ndt/gfm366
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发表时间：
2007-11-01
影响因子：
6.1
通讯作者：
Romero, Ramon
中科院分区：
文献类型：
--
作者：
Ballarin, Jose;Poveda, Rafael;Romero, Ramon
背景。膜性肾病是成人肾病综合征（NS）的常见病因。治疗方法仍在争论中。我们报告了我们在一项初步研究中使用低剂量类固醇和他克莫司（Tac）的经验。治疗3个月后，如果蛋白尿高于1g/d，则加加霉酚酸酯（MMF）。按照这一标准，21例患者进入研究。在类固醇和Tac治疗的第3个月，11例患者的蛋白尿水平低于1g/天。这些患者持续这种治疗12个月。9例患者在第3个月后加入MMF治疗，三联治疗持续12个月以上。两名患者因副作用而停药。在治疗结束时，所有患者中有15人（71.4人）出现NS缓解。8例（53.3例）患者NS完全缓解，7例（46.7例）患者NS部分缓解。其余4名患者没有反应。肾功能无明显变化。在停药后平均23.1个月，11例（73.3例）患者复发。在这项试验中，他克莫司治疗显示出良好的疗效，但停药后复发率很高。
Background. Membranous nephropathy is a common cause of nephrotic syndrome (NS) in adults. Its treatment is still under debate.Methods. We report our experience in a pilot study using initially low doses of steroids and tacrolimus (Tac). After 3 months of treatment, mycophenolate mofetil (MMF) was added if the proteinuria was higher than 1g/day.Results. In accordance with this standard, 21 patients entered the study. A proteinuria level lower than 1g/day was reached at month 3 of therapy with steroids and Tac in 11 patients. These patients continued this treatment for 12 months. MMF was added in nine cases after the third month and triple therapy was maintained for 12 more months. Two patients were withdrawn because of side effects. At the end of the treatment, remission of the NS was present in 15 out of all the patients (71.4). Remission of the NS was complete in eight (53.3) patients and partial in seven (46.7) others. The remaining four patients did not respond. There were no significant changes in renal function. At a mean time of 23.1 months after treatment was discontinued, 11 (73.3) patients had relapsed.Conclusions. In this trial, treatment with tacrolimus showed a good efficacy but a high relapse rate when it was discontinued.