腎機能が悪化したイディオパシー膜性腎不全におけるプレドニソロンとクロラムビシルの治療
P W Mathieson1, A N Turner, C G Maidment
1Department of Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, London.
Lancet (London, England)
|October 15, 1988
まとめ
この研究では,プレドニゾロンとクロラムビシルの治療を交互にすると,腎機能が低下している患者でも,プロテインウリアが著しく減少し,イディオパシー性膜性腎不全の患者でも腎機能が改善することが示されています.
科学分野:
- ネフロロジーはネフロロジーを用います.
- 免疫抑制療法による免疫抑制療法
背景:
- Idiopathic membranous nephropathy (IMN) は,成人における腎不全症候群の主要な原因である.
- IMNでは進行性腎不全が起こり,効果的な治療戦略が必要になります.
研究 の 目的:
- IMNおよび腎機能の悪化を有する患者におけるプレドニゾロンとクロラムビシルの月間サイクルを交互に投与する有効性を評価する.
- タンパク質尿と腎機能パラメータに対するこのレジメンの影響を評価する.
主な方法:
- IMNと腎機能低下の8人の患者からなるコホートは,6ヶ月の治療コースを受けた.
- 治療は,プレドニゾロンとクロラムビシルの月間サイクルを交互に服用することでした.
- タンパク質尿とクレアチニンクリアランスは,研究中ずっとモニタリングされていました.
主要な成果:
- すべての患者はタンパク質尿の有意な減少を経験しました (平均15.3g/24hから2.1g/24h).
- クレアチニンクリアランスは6人の患者で有意に改善し,2人の患者で安定した (平均51.6ミリ/分から81.4ミリ/分).
- クロランブシルの重度の副作用により,投与量を減らす必要がありました.
結論:
- プレドニゾロンとクロラムビシルを交互に服用すると,既存の腎機能不全でも,IMNの自然な経路を変えることができます.
- この治療アプローチは,腎機能が悪化している高リスクのIMN患者にとって有益である可能性があります.
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