Enhanced Steroid Therapy in Adult Minimal Change Nephrotic Syndrome: A Systematic Review and Meta-analysis

Zhao, Lingfei; Cheng, Jun; Zhou, Jingyi; Wu, Congcong; Chen, Jianghua

doi:10.2169/internalmedicine.54.3927

Cited by 11 publications

(5 citation statements)

References 32 publications

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“…Consequently, most clinicians recommend treatment for minimal change disease patients with high doses of corticosteroids. However, this is a rare disease and there is a paucity of data from randomized controlled trials in adults on the efficacy of therapy [10][11][12] . Many adult patients require a prolonged initial course of corticosteroids to enter remission 9,[13][14][15] .…”

Section: Introductionmentioning

confidence: 99%

Randomized, Controlled Trial of Tacrolimus and Prednisolone Monotherapy for Adults with De Novo Minimal Change Disease

Medjeral-Thomas

Lawrence

Condon

et al. 2020

CJASN

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Background and objectives: Minimal change disease is an important cause of nephrotic syndrome in adults. Corticosteroids are first-line therapy for minimal change disease but a prolonged course of treatment is often required, and relapse rates are high. Patients with minimal change disease are therefore often exposed to high cumulative corticosteroid doses and are at risk of associated adverse effects. This study investigated whether tacrolimus monotherapy without corticosteroids would be effective for the treatment of de novo minimal change disease. Design, setting, participants and measurements: This was a multicenter prospective, open-label, randomized controlled trial involving 6 nephrology units across the UK. Adult patients with first presentation of minimal change disease and nephrotic syndrome were randomized to treatment with either oral tacrolimus at 0.05mg/kg twice daily, or prednisolone at 1mg/kg daily up to 60mg daily. The primary outcome was complete remission of nephrotic syndrome after 8 weeks of therapy. Secondary outcomes included remission of nephrotic syndrome at 16 and 26 weeks, rates of relapse of nephrotic syndrome and changes from baseline renal function. Results: There were no significant differences between the tacrolimus and prednisolone treated cohorts in the proportion of patients in complete remission at 8 weeks, 21 of 25 (84%) for prednisolone and 17 of 25 (68%) for tacrolimus (p=0.32, differences in remission rates were 16% (95% CI-10.5% to 40.1%)), at 16 weeks, 23 of 25 (92%) for prednisolone and 19 of 25 (76%) for tacrolimus (p=0.25, difference in remission rates 16% (95% CI-7.9% to 38.0%)), or at 26 weeks, 23 of 25 (92%) for prednisolone and 22 of 25 (88%) for tacrolimus (p=0.99, difference in remission rates 4% (95% CI-17.4% to 25.4%)). There was no significant difference in relapse rates (17 of 23 (74%) for prednisolone and 16 of 22 (73%) for tacrolimus) for patients in each group who achieved complete remission (p=0.99), or in the time from complete remission to relapse. Conclusion: Tacrolimus monotherapy can be effective alternative treatment for patients wishing to avoid steroid therapy for minimal change disease.

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Section: Introductionmentioning

confidence: 99%

Randomized, Controlled Trial of Tacrolimus and Prednisolone Monotherapy for Adults with De Novo Minimal Change Disease

Medjeral-Thomas

Lawrence

Condon

et al. 2020

CJASN

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“…MCD is generally a steroid-sensitive disease; however, the rate of response of MCD to corticosteroid therapy is lower in adults compared with children, and more prolonged therapy is required to achieve a remission [17]. A systematic review of the treatment of MCD concluded that patients treated with steroid pulse therapy achieved complete remission sooner and showed fewer adverse events than did patients receiving oral steroid monotherapy [18], but complete remission rates and relapse rates were similar in both groups. Steroid pulse therapy was not performed in the previously reported 4 cases of de novo MCD during pregnancy; however, steroid pulse therapy should be particularly considered for pregnant women with nephrotic syndrome, for whom acute kidney injury threatens.…”

Section: Discussionmentioning

confidence: 99%

Steroid Pulse Therapy for De Novo Minimal Change Disease During Pregnancy

et al. 2017

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Patient: Female, 30Final Diagnosis: Minimal change diseaseSymptoms: Oliguria • systemic edemaMedication: —Clinical Procedure: Steroid pulse therapySpecialty: Obstetrics and GynecologyObjective:Rare diseaseBackground:Nephrotic syndrome occurs very rarely, in only about 0.01–0.02% of all pregnancies, and de novo minimal change disease during pregnancy is especially rare. Nephrotic syndrome and, especially, minimal change disease are highly responsive to steroids, and preterm labor may be avoidable if the maternal condition is improved with steroid therapy. Therefore, prompt diagnosis and proper management are critical to maternal and fetal outcome when severe proteinuria occurs during pregnancy.Case Report:A 30-year-old pregnant Japanese woman presented with systemic edema, oliguria, and severe proteinuria and hypoalbuminemia at 25 weeks of gestation, although she was normotensive. The patient had high urinary protein selectivity. Her illness was diagnosed as de novo nephrotic syndrome with high steroid responsiveness rather than pre-eclampsia. She began steroid pulse therapy the day after admission. Complete remission was confirmed after 3 weeks. The patient did not relapse during pregnancy and delivered a healthy male baby at 37 weeks of gestation. A renal biopsy at a relapse after delivery confirmed minimal change disease.Conclusions:In pregnant women with de novo minimal change disease, serious maternal and/or fetal complications may occur if severe proteinuria and hypoalbuminemia are unabated for an extended time. Evaluation of urinary protein selectivity is noninvasive and useful for prediction of steroid responsiveness. Results of urinary protein selectivity can be obtained earlier than results of renal biopsy. Renal biopsy during pregnancy is not always necessary for initiation of steroid therapy. Rapid initiation of steroid pulse therapy may enable quicker achievement of remission and prevent serious perinatal complications.

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“…In the clinic, relapse is very common in these patients and then high-dose or long-term steroid therapy is often recommended. However, repeated and prolonged steroid therapy is associated with an excess of adverse events, some of which are dose related (Zhao et al, 2015a). Previous studies confirmed that US combined with MBs could enhance the delivery of genes or drug to target areas of tissues including the kidney (Ibsen et al, 2013;Aryal et al, 2014;Huang et al, 2016;Wei et al, 2016).…”

Section: Downloaded Frommentioning

confidence: 99%

Ultrasound Combined with Microbubbles Enhances the Effects of Methylprednisolone in Lipopolysaccharide-Induced Human Mesangial Cells

Tian

Chen

et al. 2018

J Pharmacol Exp Ther

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Enhanced Steroid Therapy in Adult Minimal Change Nephrotic Syndrome: A Systematic Review and Meta-analysis

Cited by 11 publications

References 32 publications

Randomized, Controlled Trial of Tacrolimus and Prednisolone Monotherapy for Adults with De Novo Minimal Change Disease

Randomized, Controlled Trial of Tacrolimus and Prednisolone Monotherapy for Adults with De Novo Minimal Change Disease

Steroid Pulse Therapy for De Novo Minimal Change Disease During Pregnancy

Ultrasound Combined with Microbubbles Enhances the Effects of Methylprednisolone in Lipopolysaccharide-Induced Human Mesangial Cells

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