[Immunosuppressive treatment of idiopathic membranous glomerulonephritis with nephrotic syndrome]

The effects of two immunosuppressive therapeutic protocols have been analyzed to evaluate the influence of treatments on the level of proteinuria, value of creatinine clearance and the level of serum albumin of patients with idiopathic membranous glomerulonephritis (IMGN) and nephrotic syndrome.

We studied 30 patients with IMGN and NS. In one group, patients were treated with corticosteroids in dose of 1 mg/kg of body weight for 4 weeks, followed by gradual reduction of dose to 0.5 mg/kg, in combination with one monthly pulses of cyclophosphamide i.v. in dose of 10 mg/kg for six months, followed by pulses treatment in three months intervals. In second group cyclosporine therapy was used in dose of 3-5 mg/kg, maintaining the medication serum level at 120 +/- 20 ng/ml. The research encompassed time period from 2000 to the end of 2007, while the parameters were tested every 2 months up to 24 months in total.

The obtained results showed that a significant reduction of proteinuria (p < 0.05) was reached in both analysed groups during the period from 6 to 9 months from the beginning of therapy. The preservation of the stabile status of the kidney function was attained as well as the insignificant variation in serum creatinine, before and after the therapy in both analysed groups. Decrease in average serum creatinine values in cyclophosphamide group (from 133.9 to 115.5 micromol/l) and the increase in the cyclosporine group (from 85.0 to 100.3 micromol/l) point to somewhat better preservation of kidney function in the cyclophosphamide group. Complete remission of nephrotic syndrome was achieved in 40% of the patients in the cyclophosphamide group, while 60% achieved partial remission. In 27% of the cyclosporine group patients complete remission was achieved, in 60% partial remission, while in 13% of them decrease of proteinuria without remission of the nephrotic syndrome.

The cyclophosphamide therapy, in combination with steroids, proved to be a good choice, whereas the cyclosporine therapy proved as a prosperous alternative in treatment of patients with IMGN.