Outcome of idiopathic membranous nephropathy with nephrotic syndrome

Aim: The aim of the research was to compare outcome of nephrotic syndrome (NS) in patients with idiopathic membranous nephropathy (IMN) and assess the therapeutic effects combination of corticosteroids and cyclophosphamide, as well as the application of cyclosporine in terms of reaching partial or complete remission of nephrotic syndrome. Patients and methods: We studied 30 patients with IMGN and NS. The parameters were tested every 2 months during 2 years, supervising renal surviving in the period of five years. In one group, patients were treated with corticosteroids in dose of 1 mg/kg of body weight for 4 weeks, followed by gradual reduction of dose to 0,5 mg/kg of body weight, in combination with one monthly pulses of cyclophosphamide i.v. in dose of 10 mg/kg of body weight for six months and two pulses in three months intervals. In second group cyclosporine therapy was used in dose of 3-5 mg/kg of body weight, with maintenance of the serum level of medication at 120+/-20 ng/ml. Results: Complete remission of NS was achieved in 40% of the patients in the cyclophosphamide group, while 60% achieved partial remission. In 27% of the cyclosporine group patients was achieved complete remission, in 60% partial remission, while in 13% of them decrease of proteinuria without accomplishment remission of the NS was achieved. There is statistically significant difference in outcome of disease analyzed through percentage of partial, complete remission and percentage of patients without remission of the disease within targeted groups after 12 (p=0,0002), 18 (p=0009) i 24 months of observing in adventage of cyclophosphamide group. Uniform maintenance of kidneys function is noted with regard to the initial values of serum creatinine in both observed groups in first 9 months of observation and afterwards better preservation of kidneys function in cyclophosphamide group. Conclusion: The cyclophosphamide therapy in combination with steroids, was presented as a useful initial therapy in patients with IMN and NS, while therapy by cyclosporine was presented as safe, alternative therapeutic option.