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Kidney Week

Abstract: TH-PO1020

Five-Year Outcomes of Idiopathic Membranous Nephropathy and Nephrotic Syndrome After a Combination Treatment with Mizoribine and Low-Dose Prednisone

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials


  • Matsumoto, Yoshihiro, Shizuoka City Hospital, Shizuoka, Japan
  • Shimada, Yasushi, Shizuoka City Hospital, Shizuoka, Japan
  • Nojima, Youichi, Shizuoka City Hospital, Shizuoka, Japan
  • Iguchi, Koichiro, Shizuoka City Hospital, Shizuoka, Japan
  • Mori, Yasuo, Shibukawa Clinic, Shizuoka, Japan

Patients with idiopathic membranous nephropathy (IMN) showing persistent high-grade proteinuria have the highest risk for developing end-stage renal failure. We previously reported the favorable short-term outcomes of treatment with mizoribine followed by low-dose prednisone. The purpose of the present study was to assess the long-term efficiency of this combined treatment in a larger number of patients.


Between 2004 and 2014, 22 patients with IMN and nephrotic-range proteinuria were administered the combined treatment. Mizoribine was initiated at a dose of 150 mg/day; after 1–3 months, 20 mg/day prednisone was added. The dosage of prednisone or mizoribine was tapered according to the urinary protein-to-creatinine ratio (P/C). For some of the patients who experienced side effects, relapse, or no response (NR), other immunosuppressive regimens were substituted. We evaluated patient outcomes for up to 5 years after initiating the combination therapy. The statuses of patients who were not followed up after the achievement of complete remission (CR), defined as a decrease in urinary P/C to <0.5, were assessed through a follow-up interview


Before treatment, patient urinary P/C ranged from 3.7 to 15.9 g/g. At 1, 2, and 3 years after combination therapy, 68%, 77%, and 77% of patients attained CR, respectively. The 5-year actual rates for CR, partial remission, NR, two-fold Cr increase, and death were 82%, 14%, 5%, 5%, and 0%, respectively. Sixteen patients (73%) stopped treatment after 9–53 months of combination therapy. In patients who achieved at least one CR, the 3-year actual risk of relapse was 11%. Side effects, including fracture, were observed in four patients.


The addition of prednisone after mizoribine monotherapy resulted in fast and safe remission in a high proportion of patients with IMN and nephrotic syndrome. The risks associated with immunotherapy might be decreased by the initial prescription of mizoribine alone, which may act as a base for establishing therapy, followed by low-dose prednisone treatment.