Nephrotic syndrome caused by membranous nephropathy: response to a short course of cyclophosphamide alternating with prednisolone.

Abstract

The optimal duration of immunosuppressive therapy and the timing of treatment for treating membranous nephropathy (MN) have yet to be established. We examined outcomes of a short course of cyclophosphamide alternating with prednisolone for MN patients with nephrotic syndrome. Cyclophosphamide (2 mg/kg/day for 8 weeks) combined with prednisolone (1 mg/kg every 48 hours for 8 weeks, then tapering off for 1 year) was prescribed for 28 MN patients (12 men and 16 women; mean age 52.4+/-2.25 years SEM). We first evaluated the response rates to this combined therapy, then compared the clinical characteristics of those who achieved remission (group A) with those who did not (group B) within 6 months of the start of treatment. The incidences of complete and partial remission increased with the follow-up period; 32 and 21% by 6 months, 54 and 29% by 12 months, and 79 and 11% by 24 months, respectively. Serum IgG (906+/-100.8 versus 562+/-66.1 mg/day; p<0.01) was significantly higher in group A, and the selectivity index (C(IgG)/C(albumin) 0.16+/-0.015 versus 0.30+/-0.040; p<0.01), significantly lower. Nephrotic syndrome persisted in 3 group B patients (23%), who finally had impaired renal function. MN patients with nephrotic syndrome responded favorably to a short course of cyclophosphamide combined with prednisolone. The serum IgG level and selectivity index may serve as markers of early response to this treatment.