Idiopathic Membranous Nephropathy and Treatment Related Complications

Abstract

Introduction: Idiopathic Idiopathic membranous nephropathy (iMN) is an immune-complex mediated renal disease which is usually associated with the nephrotic syndrome (NS). The course of the disease is variable. Some patients maintain normal kidney function with or without a spontaneous remission of proteinuria, while others progress to end-stage renal failure or die from complications related to the nephrotic syndrome. Whether or not to treat a patient with idiopathic membranous nephropathy is still controversial. The controversy is mainly related to the toxicity of the therapy and the variable natural course of the disease-spontaneous remission occurs in 40–50% of patients. Aim: The aim of this study was to describe our experience of treatment of an idiopathic membranous nephropathy (iMN), efficacy and complications rate. Case report: Our patient was older, mail gender, in high-risk group with persistent proteinuria 10,68 g/day and stable renal function. We have taken these factors into consideration, along with age and other comorbidities, that may significantly elevate the risk of treatment. We chose to start with early treatment, following the Ponticelli’s group protocol based on high dose corticosteroids (odd months) alternating with clorambucil (even months) for six months. This treatment was accompanied by the steroid side effects, including hyperglycaemia dependance on insulin therapy and pulmonary thromboembolism despite administered prophylactically low molecular weight heparin. The six-month treatment was successfully completed with the reduction of proteinuria to nephritic values 2,86 g/day, despite many complications. Complete remission of the disease with non-significant proteinuria and with stable renal function was achieved in 14 months which has been maintained for 2 years. Conclusion: We suggest that decisions on the timing of start of therapy, whom to treat, best sequence of the use of the various immunosuppressive drugs must be based on an individualized assessment of risks and benefits.

Network pharmacology and molecular docking predictions of the active compounds and mechanism of action of Huangkui capsule for the treatment of idiopathic membranous nephropathy

“…However, it is impossible to overlook the negative effects of hormone therapy, and IMN following hormone therapy is still prone to relapse. [5] Over the course of thousands of years, Traditional Chinese Medicine (TCM) has amassed invaluable information in the fight against diseases. Water hibiscus, also known as huangkui (Abelmoschus manihot), has a history that dates back to Ge Hong "Prescriptions for Emergent Reference" in the Eastern Jin Dynasty (3-4th century AD), or roughly 2000 years ago.…”

“…However, it is impossible to overlook the negative effects of hormone therapy, and IMN following hormone therapy is still prone to relapse. [ 5 ]…”

Comparison of cyclophosphamide and calcineurin inhibitors for idiopathic membranous nephropathy

“…Approximately 80% of the cases are classified as primary or idiopathic membranous nephropathy (IMN) in which the autoimmunity cause remains unknown. IMN is a chronic disease with a clinical course that is difficult to predict because many patients achieve spontaneous and have good prognosis, but others progress to end stage renal disease [6,7] . Approximately 40% to 50% of the patients achieve complete or partial remission of proteinuria spontaneously usually with renal stability whereas a gradual progression to end stage renal disease is observed in 5 to 15 years in rest of the patients [8] …”

“…IMN is a chronic disease with a clinical course that is difficult to predict because many patients achieve spontaneous and have good prognosis, but others progress to end stage renal disease. [6,7] Approximately 40% to 50% of the patients achieve complete or partial remission of proteinuria spontaneously usually with renal stability whereas a gradual progression to end stage renal disease is observed in 5 to 15 years in rest of the patients. [8] Alternating monthly cycles of alkylating agents [especially cyclophosphamide (CTX)] and corticosteroids has been proven to be more effective than corticosteroids alone in inducing remissions and preserving renal function.…”