Clinical profile, response and outcome of variousimmunosuppressive regimens used for treatment ofidiopathic membranous nephropathy—a retrospective cohort study
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Keywords
Glomerular diseases; Membranous nephropathy; Immunosuppression; Outcome
Abstract
Background: Membranous nephropathy (MN) is a glomerular disease commonly presenting as a nephrotic syndrome in adults. Various immunosuppressive medications have been used in the treatment of the same with different levels of success. Hence we have undertaken a retrospective analysis of “Clinical profile, response and outcome of various immunosuppressive regimens used for treatment of membranous nephropathy” to determine the efficacy of each treatment regimen. Methods: A retrospective observational cohort study was conducted in a single tertiary care centre in southern India. Patients with proven primary membranous nephropathy from 2010 to June 2020 with a minimum duration of follow-up of one year and treated with different immunosuppressive regimens were included in the study. Results: The total number of patients in the study was 129. Mean age of onset was 39 years with a follow-up of a minimum of 1 year and a maximum of 10 years, the mean follow-up being 3 years. 46.5% achieved complete remission, 23.3% had partial remission and 10.9% had relapse, doubling of serum creatinine was seen in 5 (3.9%) and chronic kidney failure requiring kidney replacement therapy in 3 (2.3%) respectively. Presence of interstitial fibrosis and tubular atrophy (IFTA) had a significant correlation p-value 0.02, patients with IFTA less than 30% performed the best with 54/71 patients (60%) achieving remission. Conclusions: Hypertension and IFTA at presentation were predictors for worse outcomes. modified Ponticelli, followed by rituximab, were the most effective in inducing and maintaining remission.
References
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Megha Saigal, Department of Nephrology, All India Institute of Medical Sciences, 801507 Patna, India
Department of Nephrology, All India Institute of Medical Sciences, 801507 Patna, India
Swarnalatha Guditi, Department of Nephrology, Nizam’s Institute of Medical Sciences, 500082 Hyderabad, India
Department of Nephrology, Nizam’s Institute of Medical Sciences, 500082 Hyderabad, India
Gangadhar Taduri, Department of Nephrology, Nizam’s Institute of Medical Sciences, 500082 Hyderabad, India
Professor and Head, Department of Nephrology