|Title:||Early initiation of immunosuppressive treatment in membranous nephropathy patients||Authors:||Chan, Chieh Kai
Chen, Ping Min
Wu, Ching Fang
Chiu, Yen Ling
Chiang, Wen Chih
|Keywords:||Glomerulonephritis;membranous nephropathy;Nephrotic Syndrome;membranous nephropathy||Issue Date:||1-Apr-2017||Journal Volume:||116||Journal Issue:||4||Start page/Pages:||266-275||Source:||Journal of the Formosan Medical Association||Abstract:||
© 2017 Background/purpose Suggestion for the management of idiopathic membranous nephropathy (IMN) includes 6 months of observation, followed with steroid plus alkylating agent. However, delayed immunosuppression exposes the kidneys to persistent damage. This study aimed to examine the benefit of early immunosuppression in IMN patients. Methods A retrospective study was performed. From 1993 to 2013, 161 IMN patients were enrolled. Patients receiving immunosuppression within 6 months after diagnosis were classified as initial-treatment group, whereas other patients as initial-no-treatment group. The clinical outcomes and complication were examined. Result Patients in the initial-treatment group had lower serum albumin concentration, less diabetes, and were younger. Steroid monotherapy is the main immunosuppression (64.5%) in this group. The initial-treatment group had a higher complete and partial remission rate than the initial-no-treatment group 6 months (52.9% vs. 35.0%, p = 0.05) and 12 months (71.1% vs. 45.0%, p = 0.003) after diagnosis. A similar result was seen between initial-steroid monotherapy and initial-no-treatment patients. Early immunosuppression is an independent predictor of remission within 1 year [hazard ratio (HR) = 2.09; 95% confidence interval (CI) = 1.25–3.49; p = 0.005] and estimated glomerular filtration rate (eGFR) decline over 50% during the follow-up. (HR = 0.33; 95% CI = 0.13–0.86; p = 0.02). The initial-treatment group also had a low frequency of eGFR decline over 50% (p = 0.001) and low combined end-stage renal disease/mortality (p = 0.001) compared with the initial-no-treatment group, but without more immunosuppression-related complication. Conclusion In contrast to Western countries, early immunosuppression (even steroid monotherapy) in our patients is associated with better remission in the 1 st year and renal preserve. Further randomized controlled trials are needed to clarify the benefit of early immunosuppression in IMN patients, especially with oriental ethnic background.
|Appears in Collections:||醫學教育暨生醫倫理學科所|
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