Triple Therapy with Single Daily Dose of Cyclosporine in Japanese Patients with Idiopathic Membranous Nephropathy
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概要
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Objective The optimal therapeutic approach to patients with idiopathic membranous nephropathy (IMN) remains controversial. In this study, we assessed the efficacy of single daily dose cyclosporine (CsA) combined with low-dose prednisolone (PSL) and an angiotensin II receptor blocker (ARB) in patients with IMN. Methods We studied 13 nephrotic patients (8 men, 5 women) with IMN diagnosed on biopsy. An initial single daily dose of 2 mg/kg, but not exceeding 150 mg, CsA was given for 12 months, tapered by a 25 mg reduction every 2 months. An initial twice-daily dose of 0.5 mg/kg PSL was given for 2 months and was also tapered. An ARB was given to all patients and the same dosage was used throughout the study. Patients were followed up for 6 to 66 months. Results Nine patients achieved complete remission at 6.7±2.9 months, and incomplete remission was obtained in the remaining patients. After a follow-up period of 32.7±20.0 months, their serum creatinine and estimated glomerular filtration rate values were similar to baseline levels. The 9 patients who completed the treatment course have not relapsed. Moreover, there were no adverse effects requiring discontinuation of this triple therapy. Conclusion A single daily dose of CsA combined with a low dose of PSL and an ARB in new-onset nephrotic patients with IMN induced a high remission rate of nephrotic syndrome, with a low incidence of relapse and a low risk of adverse effects. The triple therapy and prospective follow-up shows potential as a treatment approach for patients with IMN.
著者
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Nakao Toshiyuki
Department Of Nephrology And Dialysis Tokyo Medical University
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Okada Tomonari
Department of Nephrology, Tokyo Medical University, Japan
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Nagaoka Yume
Department of Nephrology, Tokyo Medical University, Japan
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Wada Toshikazu
Department of Nephrology, Tokyo Medical University, Japan
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Nagaoka Yume
Department Of Nephrology Tokyo Medical University
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Okada Tomonari
Department Of Bioscience And Biotechnology Faculty Of Agriculture Kyushu University
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Wada Toshikazu
Department Of Computer And Communication Science Wakayama University
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Matsumoto Hiroshi
Department Of Architecture And Civil Engineering Faculty Of Engineering Toyohashi University Of Tech
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Gondo Asako
Department of Nephrology, Tokyo Medical University, Japan
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Esaki Shinga
Department of Nephrology, Tokyo Medical University, Japan
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Hayashi Ami
Department of Nephrology, Tokyo Medical University, Japan
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Miyaoka Yoshitaka
Department of Nephrology, Tokyo Medical University, Japan
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