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Published on: May 6, 2018
Treatment of membranous nephropathy
1Division of Nephrology, Ospedale Maggiore di Milano, Italy.
Abstract:
Several therapeutic approaches have been tried in patients with membranous nephropathy. Corticosteroids have been largely used, but a meta-analysis of the available controlled trials did not show any benefit of corticosteroids either in favouring remission of the nephrotic syndrome or in preventing renal dysfunction. Controversial results have been obtained with cytotoxic agents. Unfortunately, most of the available trials were small in size and had short-term follow-ups. Three controlled trials evaluated the role of a 6-month treatment with methylprednisolone and chlorambucil. The first trial showed that the 10-year renal survival rate was 92% in treated patients compared with 60% in untreated controls. A second trial compared the effects of methylprednisolone/chlorambucil with those of methylprednisolone alone. The combined treatment achieved remission of nephrotic syndrome in 64% of cases vs 38% in patients given steroids alone. A third trial showed equivalent results in patients randomized to be given methylprednisolone/chlorambucil or methylprednisolone/cyclophosphamide. A number of non-controlled studies and a randomized trial also showed the efficacy of cyclosporine in reducing proteinuria. In many but not all cases, proteinuria reappeared when cyclosporine was stopped. In conclusion, although the treatment of membranous nephropathy remains difficult, some therapeutical approaches have proved to favour remission and protect renal function
Insights
Corticosteroids offer no benefit for membranous nephropathy patients. Combined treatments like methylprednisolone with chlorambucil significantly improve remission rates and renal survival, offering better therapeutic options.
Area of Science:
- Nephrology
- Internal Medicine
Background:
- Membranous nephropathy treatment is challenging.
- Corticosteroids have shown limited efficacy in improving remission or preventing renal dysfunction.
- Cytotoxic agents have yielded controversial results due to small trial sizes and short follow-ups.
Purpose of the Study:
- To evaluate the efficacy of different therapeutic approaches for membranous nephropathy.
- To assess the impact of corticosteroids, cytotoxic agents, and cyclosporine on remission and renal function.
Main Methods:
- Meta-analysis of controlled trials for corticosteroids.
- Evaluation of three controlled trials on methylprednisolone and chlorambucil (6-month treatment).
- Review of non-controlled studies and a randomized trial on cyclosporine.
Main Results:
- Corticosteroids did not demonstrate benefit in remission or renal function preservation.
- Methylprednisolone/chlorambucil treatment showed a 92% 10-year renal survival rate compared to 60% in controls.
- Combined methylprednisolone/chlorambucil achieved 64% remission versus 38% for methylprednisolone alone.
- Cyclosporine demonstrated efficacy in reducing proteinuria, though often transiently.
Conclusions:
- Effective treatment for membranous nephropathy remains difficult.
- Combined therapies, such as methylprednisolone and chlorambucil, show promise in improving remission and protecting renal function.
- Cyclosporine may be effective for proteinuria reduction, but relapse is common upon discontinuation.
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