Efficacy of tacrolimus or cyclophosphamide combined with glucocorticoids in the treatment of idiopathic membranous nephropathy

Objective To observe the clinical efficacy and safety of tacrolimus (TAC) or cyclophosphamide (CTX) combined with glucocorticoids in treatment of idiopathic membranous nephropathy. Methods A retrospective study was conducted on 46 patients who had been diagnosed as idiopathic membranous nephropathy from September 2016 to September 2017 in Qianfoshan Hospital of Shandong Province. The patients were followed up for 36 weeks. The patients were divided into two groups. Twenty-seven patients were given TAC combined with glucocorticoid as experimental group. The 24-h urinary protein, serum albumin, serum creatinine, fasting blood glucose, triglyceride, total cholesterol levels and the rate of remission were recorded before and 4, 8, 12, 24, and 36 weeks after treatment. The difference in the efficacy between the two groups was compared. Results There were no significant differences in general data (gender, age, course of illness) and laboratory tests before treatment between the two groups (P>0.05). After 36 weeks of treatment, 16 cases(59.25%) obtained complete remission in the experimental group and 7 cases (36.84%) in the control group. The complete remission rate in the experimental group was significantly higher than that in the control group (P<0.01). Eight cases (29.63%) in the experimental group, and 8 cases (42.11%) in the control group obtained partial remission. Three cases had ineffective efficacy in the experimental group (11.11%), and 4 cases (21.05%) in the control group. The 24-h urinary protein quantification was significantly reduced in the two groups after treatment as compared with that before treatment (P<0.05). The 24-h urinary protein quantification in the experimental group was decreased from (10.1±3.2) g to (1.2±2.6) g (P<0.01), and that in the control group was decreased from (8.6±3.8) g to (1.7±2.7) g (P<0.01), with the difference being very statistically significant. The serum albumin level was also significantly higher after treatment in both two group than that before treatment. The serum albumin level in the experimental group was increased from (22.3±3.6) g/L to (43.0±3.3) g/L (P<0.01), and from (23.5±4.5) g/L to (40.9±6.1) g/L in the control group (P<0.01), with the difference being statistically significant. There was no significant change in serum creatinine, blood glucose, triglyceride, total cholesterol during the treatment in both groups before and after treatment (P>0.05). During the course of treatment, no serious adverse reactions such as myelosuppression occurred in both groups. Conclusions TAC combined with glucocorticoid is effective and safe in the treatment of idiopathic membranous nephropathy. As compared with CTX, TAC can rapidly reduce 24-h urine protein quantification.