Effective treatment administration of cyclophosphamide in membranous nephropathy

Idiopathic membranous nephropathy (IMN) is the most common cause of nephrotic syndrome in adults. In this prospective study, we investigated the efficacy of combined use of oral or pulse cyclophosphamide (CYC) with low-dose steroid on our group of adult IMN patients whose renal function was normal at the time of diagnosis.

The study was performed on 33 adult patients who had not previously been treated with immunosuppressive agents. All patients were treated with prednisone (0.5 mg/kg per day) for 1 year. In addition to this treatment, oral CYC (1.5-2 mg/kg per day) and pulse CYC (500 mg/m2 per month) were administered for 6 months to 17 and 16 patients, respectively.

At the end of the follow-up period, serum creatinine levels were either decreased or had remained stable in both groups. Daily protein excretion was improved in all but 3 patients. Complete or partial remission was achieved in 9 and 10 of 33 patients, respectively. Serum albumin levels were significantly increased in both groups (p=0.027). These levels were higher in the pulse CYC group than in the oral CYC group, and the difference between the 2 groups was statistically significant.

With regard to patients with IMN, the combination of CYC with corticosteroids was beneficial in conserving renal function and in induction of remission of nephrotic syndrome. We observed that pulse CYC treatment significantly increased serum albumin levels when compared with oral CYC.