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Kidney Week

Abstract: FR-PO867

Early vs. Late Start of Immunosuppressive Therapy in Membranous Nephropathy

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials


  • van de Logt, Anne-Els, Radboud University Medical Center, Nijmegen, Netherlands
  • Van de luijtgaarden, Moniek Wm, Radboud University Medical Center, Nijmegen, Netherlands
  • Vink- van Setten, Coralien, Radboud University Medical Center, Nijmegen, Netherlands
  • Svobodova, Barbora, General University Hospital, Prague, Czechia
  • Tesar, Vladimir, General University Hospital, Prague, Czechia
  • Wetzels, Jack F., Radboud University Medical Center, Nijmegen, Netherlands

Alkylating agents improve outcome in membranous nephropathy (MN). Guidelines advise restrictive treatment. Some centers wait beyond 6-12 months before start of immunosuppressive therapy. The risk of persisting proteinuria is podocyte loss, which may cause secondary focal glomerulosclerosis. This should reduce the likelihood of complete remissions. We evaluated the safety of delayed treatment.


We used data of two centers that participated in the MN registry ( In one center (Czech Republic (CZ)) treatment is started early after kidney biopsy, whereas in the Netherlands (NL) a restrictive treatment strategy is used1. For the current analysis we included incident patients, with proteinurie of > 2 grams/24 hours, treated with immunosuppressive therapy (ISRx) and available follow-up. To allow evaluation of late treatment, we included only patients from NL with an interval of more than six months from kidney biopsy. Partial and complete remissions were defined according to KDIGO criteria.


In total 155 patients were included in the analysis. Baseline information and outcomes are presented in Table 1. Alkylating agents were mainly used, cyclophosphamide in NL (81 %) and chlorambucil in CZ (60 %). Overall remission rates (partial- and complete remission) calculated from start of therapy, were not different . Most importantly, also with delayed therapy complete remissions were observed frequently (Table 1).


The MN registry allows comparison of treatment protocols between centers. Our data support the safety of a delayed treatment strategy.

Baseline characteristics and outcome
Mean age (years)54 ± 1356 ± 15
Gender (% males)68 (76 %)43 (66 %)
Screatinine (µmol/l)90 [75-106]93 [74-133]
UPCR (g/10 mmol)7.9 [5.9-10.9]6.6 [4.7-10.8]
Salbumine (g/l)22 [18-26]20 [16-24]
Interval biopsy till start of ISRx (months)10.9 [8.1-19.5]0.0 [0.0-0.0]
Follow-up duration (years)7.3 [3.8-11.5]2.2 [1.0-3.6]
N (%) PR after 1 year67 (74 %)48 (74 %)
N (%) CR after 1 years34 (38 %)15 (23 %)
N (%) PR after 2 years85 (94 %)48 (74 %)
N (%) CR after 2 years45 (50 %)15 (23 %)

Mean±SD, Median [IQR]


  • Government Support - Non-U.S.