A controlled trial of cyclosporine in patients with progressive membranous nephropathy

Abstract

A controlled trial of cyclosporine in patients diagnosed with progressive membranous nephropathy (MGN) was carried out to determine whether cyclosporine (D) would be more effective than placebo (P) in reducing the rate of deterioration in renal function. Patients (N = 64) with MGN were placed on a restricted protein diet (< or = 0.9 g/kg) and followed closely for 12 months (Part 1). Patients at high risk of progression based on an absolute loss in creatinine clearance (CCr) of > or = 8 ml/min and persistent nephrotic range proteinuria (Pr) were selected and randomly assigned to either (D) (N = 9) or (P) (N = 8) for 12 months (Part 2). No differences in the two groups were noted at entry. After 12 months, the improvement in CCr slope in ml/min/month was significantly greater in the D patients (D + 2.1 vs. P + 0.5, mean difference 1.6; 95% CI 0.3 to 3.0, P < 0.02). This improvement was maintained in six of eight D (75%) over a mean follow-up period of 21 months. Daily Pr also improved with D (by month 3, D - 4.5 g/day vs. P + 0.7 g/day, P = 0.02) and was sustained in six of eight (75%) D patients. When Pr was expressed as a function of their concurrent CCr, the D versus P patients' time to halving was faster (P = 0.02) and absolute number higher (4/9 D vs 0/8 P). In the D group a trend towards worse hypertension and an increase in the number of transient rises in serum creatinine were noted.(ABSTRACT TRUNCATED AT 250 WORDS)

Have We Changed the Outcome in Membranous Nephropathy? A Propensity Study on the Role of Immunosuppressive Therapy

“…The immunosuppressive recommendations for MGN based on RCTs include cyclophosphamide, chlorambucil, and cyclosporine regimens (5,18,(33)(34)(35). Most of these, but not all, concomitantly used corticosteroids.…”

Venous Thromboembolism in Patients with Membranous Nephropathy

“…We studied a large pooled inception cohort of patients identified at the time of biopsy diagnosis of GN and followed by prospective accrual of data from each clinic visit (10,11). For both registries, medical records were collected from the initial biopsy diagnosis or earliest available clinical presentation.…”

“…We conducted a retrospective analysis of clinically apparent thromboembolic events in 898 patients with biopsy-proven MN diagnosed between 1969 and 2007 (10,11).…”

Long-term outcome of patients with acquired primary idiopathic pure red cell aplasia receiving cyclosporine A. A nationwide cohort study in Japan for the PRCA Collaborative Study Group

“…The causes of death were the development of aplastic anemia, renal failure with membranous nephropathy, liver failure associated with hepatitis B virus infection and gastric carcinoma. The relationship of CsA with the former three diseases is unclear because CsA is one of the effective treatments for aplastic anemia, 20 membranous nephropathy 21 and probably for hepatitis B virus infection as well. 22 Although immunosuppressive therapy enhances viral replication, it has been shown that CsA by itself impairs hepatitis B virus replication by blocking cytosolic calcium signaling.…”