Frank J. Bruns, MD; Sheldon Adler, MD; Donald S. Fraley, MD; David P. Segel, MD
Objective: To determine the effect of cyclophosphamide and prednisone on progressive renal failure and on nephrotic features in patients with membranous glomerulonephritis.
Design: Prospective, nonrandomized time series.
Setting: Outpatient clinic at a university medical center.
Patients: Eleven consecutive patients with biopsy-proven membranous glomerulonephritis and rising plasma creatinine levels over at least 6 months.
Intervention: Cyclophosphamide and prednisone in ten patients and cyclophosphamide alone in one patient.
Measurements and Main Results: In ten patients treated with both agents, the median plasma creatinine rose 53 µmol/L (0.6 mg/dL) over the months before treatment from 141 to 194 µmoL/L (1.6 to 2.2 mg/dL) (95% CI, 27 to 141 µmol/L; P = 0.002). After combined therapy for 6 months, the median plasma creatinine fell to 133 µmol/L (1.5 mg/dL) for a median decline of 62 µmol/L (0.7 mg/dL) (CI, 44 to 150 µmol/L; P = 0.006). Pretreatment plasma creatinine levels, which ranged from 159 to 371 µmol/L (1.8 to 4.2 mg/dL), decreased in the ten patients by 6 months and remained stable in seven of the eight patients followed 24 to 54 months after therapy was completed. The median urine protein excretion decreased by 9.6 g/d with 12 months of therapy in the ten patients from 11.9 to 2.3 g/d (CI, 6.0 to 15.1 g/d; P < 0.001). The median plasma albumin rose by 14 g/L from 24 to 38 g/L (CI, 11 to 19 g/L; P < 0.001). The median plasma cholesterol fell by 3.26 µmol/L (140 mg/dL) from 10.45 to 6.52 µmol/L (405 to 252 mg/dL) (CI, 1.42 to 7.16 µmol/L; P = 0.01). One patient who had a relapse 30 months after completing therapy responded to re-treatment with renal function and nephrotic variables returning toward normal. The eleventh patient received cyclophosphamide alone and had a course similar to that of the combined therapy group.
Conclusion: Cyclophosphamide plus prednisone can promote prolonged remissions in membranous glomerulonephritis even when renal function is already declining.
Bruns FJ, Adler S, Fraley DS, et al. Sustained Remission of Membranous Glomerulonephritis after Cyclophosphamide and Prednisone. Ann Intern Med. 1991;114:725–730. doi: https://doi.org/10.7326/0003-4819-114-9-725
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Published: Ann Intern Med. 1991;114(9):725-730.
Autoimmune Kidney Disease, Nephrology, Rheumatology.
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