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Stepwise Treatment Using Corticosteroids Alone and in Combination with Cyclosporine in Korean Patients with Idiopathic Membranous Nephropathy

 Dong Ho Shin  ;  Mi Jung Lee  ;  Hyung Jung Oh  ;  Hyang Mo Koo  ;  Fa Mee Doh  ;  Hyoung Rae Kim  ;  Jae Hyun Han  ;  Jung Tak Park  ;  Seung Hyeok Han  ;  Kyu Hun Choi  ;  Tae-Hyun Yoo  ;  Shin-Wook Kang 
 YONSEI MEDICAL JOURNAL, Vol.54(4) : 973-982, 2013 
Journal Title
Issue Date
Adrenal Cortex Hormones/adverse effects ; Adrenal Cortex Hormones/therapeutic use* ; Adult ; Aged ; Cyclosporine/adverse effects ; Cyclosporine/therapeutic use* ; Drug Administration Schedule ; Female ; Glomerular Filtration Rate/drug effects ; Glomerulonephritis, Membranous/drug therapy* ; Glomerulonephritis, Membranous/mortality ; Humans ; Immunosuppressive Agents/adverse effects ; Immunosuppressive Agents/therapeutic use* ; Kaplan-Meier Estimate ; Kidney/drug effects ; Kidney/physiology ; Male ; Middle Aged ; Proteinuria/chemically induced ; Treatment Outcome
Corticosteroids ; cyclosporine ; idiopathic membranous nephropathy ; nephrotic syndrome ; remission
PURPOSE: We undertook an observational study to investigate the effects of immunosuppressive treatment on proteinuria and renal function in 179 Korean idiopathic membranous nephropathy patients with nephrotic syndrome. MATERIALS AND METHODS: The primary outcome was regarded as the first appearance of remission and the secondary outcomes as a decline in estimated glomerular filtration rate (eGFR) >50% or initiation of dialysis, and all-cause mortality. Seventy-two (40.2%) and 50 (27.9%) patients were treated with corticosteroids alone (C) and corticosteroids plus cyclosporine (C+C), respectively, whereas 57 (31.8%) did not receive immunosuppressants (NTx). Cyclosporine was added if there was no reduction in proteinuria of >50% from baseline by corticosteroids alone within 3 months. RESULTS: There were no differences in baseline renal function and the amount of proteinuria among the three groups. Overall, complete remission (CR) was achieved in 88 (72.1%) patients by immunosuppressants. In a multivariate analysis adjusted for covariates associated with adverse renal outcome, the probability of reaching CR was significantly higher in the C [hazard ratio (HR), 4.09; p<0.001] and C+C groups (HR, 2.57; p=0.003) than in the NTx group. Kaplan-Meier analysis revealed that 5-year CR rates of C, C+C, and NTx groups were 88.5%, 86.2%, and 56.7% (p<0.001). Ten-year event-free rates for the secondary endpoints in these three groups were 91.7%, 79.9%, and 57.2% (p=0.01). CONCLUSION: Immunosuppressive treatment was effective in inducing remission and preserving renal function in these patients. Therefore, stepwise treatment using corticosteroids alone and in combination with cyclosporine is warranted in these patients.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Shin Wook(강신욱) ORCID logo https://orcid.org/0000-0002-5677-4756
Koo, Hyang Mo(구향모)
Kim, Hyoung Rae(김형래)
Doh, Fa Mee(도화미) ORCID logo https://orcid.org/0000-0002-4780-6728
Park, Jung Tak(박정탁) ORCID logo https://orcid.org/0000-0002-2325-8982
Oh, Hyung Jung(오형중)
Yoo, Tae Hyun(유태현) ORCID logo https://orcid.org/0000-0002-9183-4507
Lee, Mi Jung(이미정)
Choi, Kyu Hun(최규헌) ORCID logo https://orcid.org/0000-0003-0095-9011
Han, Seung Hyeok(한승혁) ORCID logo https://orcid.org/0000-0001-7923-5635
Han, Jae Hyun(한재현)
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