Induction and long-term treatment with cyclosporine in membranous nephropathy with the nephrotic syndrome

Alexopoulos, Efstathios; Papagianni, Αikaterini; Tsamelashvili, Mzia; Leontsini, Maria; Memmos, Dimitrios

doi:10.1093/ndt/gfl360

Cited by 89 publications

(59 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…High rates of relapses were noted in most studies with sufficient follow-up duration (Table 3). In the study of Alexopoulos et al, it was suggested that combination therapy with CsA and steroids is more effective in inducing remission and preventing relapses as compared with CsA monotherapy [60]. In this study, 31 patients were treated with a combination of CsA and prednisone and 20 with CsA monotherapy.…”

Section: Treatmentmentioning

confidence: 88%

Pharmacological treatment of primary membranous nephropathy in 2016

Logt¹,

Hofstra²,

Wetzels³

2016

Expert Review of Clinical Pharmacology

View full text Add to dashboard Cite

show abstract

Section: Treatmentmentioning

confidence: 88%

Pharmacological treatment of primary membranous nephropathy in 2016

Logt¹,

Hofstra²,

Wetzels³

2016

Expert Review of Clinical Pharmacology

View full text Add to dashboard Cite

show abstract

“…On the other hand, if after 3 to 4 mo of CsA therapy at adequate doses proteinuria is not significantly reduced, then it is unlikely that the therapy will be effective. Prolonged low-dose CsA (approximately 1.5 mg/kg per d) could be considered for long-term maintenance of patients with preserved renal function who achieve CR or PR but who relapse once CsA is discontinued, with little risk for nephrotoxicity (55).…”

Section: Immunosuppressive Therapymentioning

confidence: 99%

Idiopathic Membranous Nephropathy

Fervenza

Sethi

Specks

2008

Clinical Journal of the American Society of Nephrology

131

123

View full text Add to dashboard Cite

Idiopathic membranous nephropathy is still the most common glomerular disease associated with nephrotic syndrome. The greater the proteinuria, the greater the long-term risk for renal failure. In addition, patients who have membranous nephropathy with nephrotic syndrome have significant morbidity and mortality, in particular related to thromboembolic and cardiovascular complications. There is no specific treatment for membranous nephropathy. Supportive care with the use of diuretics and angiotensin-converting enzyme inhibitors in combination with angiotensin II receptor blocker is recommended, but these agents have only a limited effect. Immunosuppressive treatment options include the use of corticosteroids, alkylating agents, cyclosporin A, tacrolimus, and mycophenolate mofetil, but their use is controversial, not all have been shown to be effective, and their use can be associated with significant adverse effects. This has resulted in relatively small improvement in the prognosis of membranous nephropathy in the past 30 yr, with up to 40% of patients eventually reaching end-stage renal failure. Agents that offer more complete response rates with lower adverse effects are truly needed. Recent data suggest that B cells play a key role in the pathogenesis of a number of autoimmune diseases including membranous nephropathy and that selective depletion of B cells in humans may be beneficial in preventing the production of pathogenic immunoglobulins and subsequent renal injury.Clin Case PresentationA 32-yr-old man underwent a general medical examination at his primary care physician's office in February 2004. At that time, he was noted to have elevated total cholesterol of 353 mg/dl and triglycerides of 417 mg/dl and was started on simvastatin 40 mg/d. During the course of the next 2 mo, he started developing swelling in his feet and ankles that proceeded to involve his calves. He also developed tenderness on his left calf. A diagnosis of a deep venous thrombosis was made, and he was started on oral anticoagulant therapy. Given the increased lower extremity edema, a urinalysis was conducted, and the patient was found to have significant proteinuria, with a 24-h urine collection showing proteinuria of 9.3 g. The patient had no history of diabetes, macroscopic hematuria, or hypertension. The patient underwent extensive serologic workup including monoclonal protein studies, serum complement levels, anti-neutrophil cytoplasmic antibodies, hepatitis B and C and HIV serology, and anti-nuclear antibody, all of which were negative or in the normal range, and in July 2004, he was referred to our institution for further evaluation. At presentation at the Mayo Clinic, the physical examination was of a healthy-appearing young man. His BP was 136/87 mmHg, pulse rate was 69, weight was 89.8 kg, and body mass index was 29 kg/m 2 . Eyes, nose, and throat examination was normal.There was no lymphadenopathy. Heart examination showed regular rate and rhythm with no murmurs. Lungs were clear to auscultation. Abdomen was soft, with no ...

show abstract

“…In these patients, prospective randomized clinical trials have demonstrated that the calcineurin inhibitors (CNIs) cyclosporine (5,6) and tacrolimus (7) induce complete or partial remission of proteinuria in more than 70% of patients. However, more than 60% of patients treated with CNI suffer subsequent relapses or become treatment dependent (5)(6)(7)(8) and need prolonged therapy to maintain remission, which exposes them to the nephrotoxic effects of this drugs. Consequently, for these patients, there is a need for the development of new treatment strategies aimed at reducing the risk of chronic nephrotoxicity.…”

mentioning

confidence: 99%