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Abstract: TH-PO1018

Treatment of Moderate and High-Risk Idiopathic Membranous Nephropathy with Intravenous Cyclophosphamide Pulses and Oral Steroid

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Ortiz Bello, Angel Cesar, Instituto Mexicano del Seguro Social, Mexico City, Mexico
  • Álvarez Rangel, Luis Enrique, Instituto Mexicano del Seguro Social, Mexico City, Mexico
  • Ruiz serrano, Ida jayna Ida jayna, Instituto Mexicano del Seguro Social, Mexico City, Mexico
Background

Idiopathic membranous nephropathy (IMN) is one of the most frequent causes of nephrotic syndrome in adults with risk of progression to end-stage renal disease. Proteinuria portend worse renal outcomes and is a risk factor for cardiovascular morbidity. The standard treatment includes oral cyclophosphamide and prednisone. Little is known about the efficacy of the treatment with pulse intravenous cyclophosphamide and oral steroid in moderate and high-risk patients and the factors associated with non-response.

Methods

A retrospective cohort study was performed on the data of patients with idiopathic membranous nephropathy. We included patients with biopsy-proven IMN treated with pulses of intravenous cyclophosphamide (750 mg/m2) and oral steroid between June 2012 to December 2017. Continuous variables were expressed as mean ± SD. Categorical variables were expressed as frequencies or proportions. Comparisons of continuous and categorical variables were performed using Student’s t-test and the Chi.square test, respectively. A p value of <0.05 was considered statistically significant. The odds ratios (OR) with their corresponding 95% confidence intervals (CI) were estimated.

Results

Sixty-one biopsy-proven IMN patients were included. The patients were predominantly male (72.1%), with mean age of the sample of 47.75 ± 12.49 years. The average eGFR was 88.85 ± 29.92 ml/min/1.73 m2 and mean baseline proteinuria was 12.13 ± 5.4 g/day. During the median follow-up duration of 26.52 ± 21.14 months, overall remission was achieved in 82% (50 cases), partial remission in 45.9% (28 cases) and complete remission in 36.1% (22 cases). The treatment failure was observed in 18% (11 cases). Adverse events related to treatment were reported in 18%. Peak proteinuria greater than 8 g/day (OR:1429, 95% CI:1192-1713) and non-reduction of proteinuria greater than 50% at month 3 (OR:3333, 95% CI:2183-5.090) were associated with the treatment failure.

Conclusion

Pulse intravenous cyclophosphamide and oral steroid is a therapeutic alternative in the treatment of idiopathic membranous nephropathy with a low incidence of adverse events. Peak proteinuria high-risk greater than 8 g/day and non-reduction of proteinuria greater than 50% at month 3 of treatment are factors associated with treatment failure.

Funding

  • Government Support - Non-U.S.