Therapy of tacrolimus combined with corticosteroids in idiopathic membranous nephropathy.

W Cui,P Luo,W Li,Q Li,Y Wang,M Luo,L Miao,X Lu,M Liu,S Guan,W Dong,X Min

doi:10.1590/1414-431x20175976

Abstract

We evaluated the efficacy and safety of tacrolimus (TAC) combined with corticosteroids in treating patients with idiopathic membranous nephropathy (IMN). One hundred seventy-seven biopsy-proven IMN patients were recruited in this retrospective clinical study. Sixty patients received TAC (target blood concentration of 4–8 ng/mL) and 117 patients received daily cyclophosphamide (CYC, 100 mg) combined with prednisone. Remission rates at the end of the first, second and third month in the TAC group were significantly higher than that in the CYC group (1st: 35.0 vs 19.7%, P<0.05; 2nd: 56.7 vs 38.5%, P<0.05; 3rd: 76.7 vs 59.0%, P<0.05). In the first 3 months, daily urinary protein and serum albumin in the TAC group obtained a better improvement than that in the CYC group (P<0.05). At the end of the sixth and the twelfth month, the remission rates, daily urinary protein and serum albumin were all comparable between the two groups (P>0.05). No significant difference of relapse rate between the groups was found (16.3 vs 12.0%, P>0.05). Patients were more likely to develop glucose intolerance in the TAC group. The TAC regimen obtained more benefits in treating IMN patients, especially in the first 3 months, than the CYC regimen.

Highlights

Idiopathic membranous nephropathy (IMN), one of the most common causes of nephrotic syndrome, is characterized by capillary wall thickening, normal cellularity, IgG and C3 along capillary walls on immunofluorescence, and subepithelial deposits on electron microscopy
Baseline characteristics of the patients were compared, and no significant differences were found between the TAC group and the CYC group (Table 1)
Treatment of IMN remains a challenge for nephrologists

Summary

Introduction

Idiopathic membranous nephropathy (IMN), one of the most common causes of nephrotic syndrome, is characterized by capillary wall thickening, normal cellularity, IgG and C3 along capillary walls on immunofluorescence, and subepithelial deposits on electron microscopy. In 2009, Beck et al first reported that the main pathogenic antibody of IMN targets m-type phospholipase A2 receptor [1]. This point of view was further confirmed by a recent meta-analysis [2]. These studies provided nephrologists with a theoretical basis for the treatment of IMN with immunosuppressive therapy. Since numerous adverse events due to the long-term use of CYC, such as irregular menstruation, cancer risk, gonadal and bladder toxicity, and infections [4,5] have been reported, alternative regimens for the initial therapy of IMN are desired

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Conclusion