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Prognosis and management of membraneous nephropathy
1Department of Medicine, Institute of Post Graduate Medical Education & Research, Calcutta.
Abstract:
Patients of idiopathic membranous nephropathy (MGN) were randomly assigned to received steroid and cyclophosphamide every other month (Gr-I) and steroid alone (Gr-II). Of 36 patients in Gr.I, 33 patients achieved complete remissions, 2 had relapsing course with remission on further courses of therapy and only one has reached end stage renal failure. In contrast, of the 35 patients in Gr. II, 15 (P < 0.001) achieved complete remission, 7 are in partial remission, 5 have no response, another 5 have deterioration of renal function of which two required dialysis, and 3 have relapsing course after the initial remission. Mean follow up period was 46 +/- 10.2 months. We conclude that steroid and cyclophosphamide every other month is highly effective in achieving remission in patients with membranous nephropathy.
Insights
Idiopathic membranous nephropathy (MGN) patients treated with steroid and cyclophosphamide showed higher remission rates. This combination therapy is highly effective for achieving remission in MGN.
Area of Science:
- Nephrology
- Immunosuppressive Therapy
Background:
- Idiopathic membranous nephropathy (MGN) is a leading cause of nephrotic syndrome in adults.
- Treatment options for MGN aim to induce remission and prevent progression to end-stage renal disease.
Purpose of the Study:
- To compare the efficacy of steroid and cyclophosphamide combination therapy versus steroid monotherapy in patients with idiopathic membranous nephropathy.
Main Methods:
- A randomized trial assigned patients with MGN to receive either steroid and cyclophosphamide every other month (Group I) or steroid alone (Group II).
- Outcomes including complete remission, partial remission, no response, and renal function deterioration were assessed.
- Mean follow-up was 46 ± 10.2 months.
Main Results:
- Group I (n=36) achieved significantly higher complete remission rates (33/36) compared to Group II (n=35) (15/35, P < 0.001).
- Fewer patients in Group I experienced relapses or end-stage renal failure compared to Group II.
- Group II showed partial remission (7), no response (5), and renal function deterioration (5), with 2 requiring dialysis.
Conclusions:
- Combination therapy with steroid and cyclophosphamide every other month is highly effective in inducing remission for idiopathic membranous nephropathy.
- This regimen offers a superior treatment option compared to steroid monotherapy for managing MGN.
- The findings support the use of this combination therapy to improve outcomes in MGN patients.