Clinical observation of low-dose cyclosporine A combined with small dose of hormone in the treatment of idiopathic membranous nephropathy

Objective To observe the clinical effect and adverse reactions of low dose of cyclosporine A combined with small dose of hormone in the treatment of idiopathic membranous nephropathy, and to explore the safe and effective treatment strategy.Methods Thirty-seven cases of idiopathic membranous nephropathy admitted at the Department of Nephrology, the First Affiliated Hosital of PLA General Hospital were given low-dose cyclosporine A (1.5~3.0 mg/kg every day) combined with small dose of glucocorticoid (prednisone 0.2~0.4 mg/kg every day). The treatment course was 12~24 months, and the follow-up period was 12-24 months. The clinical efficacy, adverse reactions and complications were observed. At 12th month during the follow-up period, the patients were divided into effective group (complete or partial remission) and ineffective group (no remission). The single factor analysis was used to analyze the prognostic factors.Results In 37 cases, 23 cases (62%) achieved complete remission, 10 cases (27%) partial remission, and 4 cases (11%) no remission. Eight cases had the effect of cyclosporine A within 4 weeks, and 4 cases relapsed in stopping drug or reducing process. Univariate analysis showed no statistically significant difference in gender between the effective and ineffective groups (P>0.05). The proportion of the patients in the ineffective group in age, and pathological stage Ⅲ and IV was significantly higher than that in the effective group, and the proportion of hypertension and microscopic hematuria before treatment in the ineffective group was significantly higher than that in the effective group (P<0.05).Conclusions Low dose of cyclosporine A combined with low dose of prednisone in the treatment of idiopathic membranous nephropathy is effective. But even such a low dose, after treatment the uric acid level is still significantly increased, because of renal tubular injury caused by cyclosporine A. The patient's age, pathological stage, hypertension and microscopic hematuria all affect the effectiveness of treatment.