Calcineurin inhibitors or cyclophosphamide in the treatment of membranous nephropathy superimposed with FSGS lesions: a retrospective study from China
AbstractBackground Cyclophosphamide (CTX) and calcineurin inhibitors (CNIs) based regimens are recommended as immunosuppressive therapies for patients with idiopathic membranous nephropathy (IMN). Focal and segmental glomerular sclerosis (FSGS) lesions, which are common in membranous nephropathy (MN...
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2023-12-01
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| Series: | Renal Failure |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/0886022X.2023.2253930 |
| _version_ | 1797211789130203136 |
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| author | Hong-Guang He Yi-Yun Huang Qin-Qing Liang Qiu-Rong Ye An-Dong Li Kun Ye Qiu-Xia Wu Yan-Wu You |
| author_facet | Hong-Guang He Yi-Yun Huang Qin-Qing Liang Qiu-Rong Ye An-Dong Li Kun Ye Qiu-Xia Wu Yan-Wu You |
| author_sort | Hong-Guang He |
| collection | DOAJ |
| description | AbstractBackground Cyclophosphamide (CTX) and calcineurin inhibitors (CNIs) based regimens are recommended as immunosuppressive therapies for patients with idiopathic membranous nephropathy (IMN). Focal and segmental glomerular sclerosis (FSGS) lesions, which are common in membranous nephropathy (MN), are poor predictors of outcome. This study compared the differences of prognosis between two regimens in patients with IMN combined with FSGS lesions.Methods This retrospective study enrolled 108 patients with biopsy-proven IMN, accompanied with FSGS lesions, nephrotic syndrome and an estimated glomerular filtration rate (eGFR)≥60 mL/min/1.73 m2 who were treated with CTX or CNIs. We used propensity score matching (PSM) for balancing the confounding variables.Results During follow-up, 10 patients (10/55 [18.2%]; nine males) in the CNIs group showed a 50% decline in eGFR; eight had a not otherwise specified variant. Patients initially treated with CNIs had a significantly higher risk of progression to the primary outcome and a lower probability of complete or total remission. The relapse rate was higher in patients who initially received CNIs- than in those who received CTX-based treatment. Before PSM, age and 24-h urine protein level differed significantly between the groups. The PSM model included data from 72 patients. Worse outcomes were also noted among patients who initially received CNIs than those who received CTX-based treatments after matching.Conclusions Patients with MN combined with FSGS lesions have a higher risk of renal functional decline and a higher rate of relapse after CNIs than after CTX therapy. |
| first_indexed | 2024-03-11T23:44:40Z |
| format | Article |
| id | doaj.art-1c8e97d1031a42959bc8bc7b3d8c410d |
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| issn | 0886-022X 1525-6049 |
| language | English |
| last_indexed | 2024-04-24T10:32:04Z |
| publishDate | 2023-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Renal Failure |
| spelling | doaj.art-1c8e97d1031a42959bc8bc7b3d8c410d2024-04-12T14:34:28ZengTaylor & Francis GroupRenal Failure0886-022X1525-60492023-12-0145210.1080/0886022X.2023.2253930Calcineurin inhibitors or cyclophosphamide in the treatment of membranous nephropathy superimposed with FSGS lesions: a retrospective study from ChinaHong-Guang He0Yi-Yun Huang1Qin-Qing Liang2Qiu-Rong Ye3An-Dong Li4Kun Ye5Qiu-Xia Wu6Yan-Wu You7Department of Nephrology, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, ChinaDepartment of Nephrology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, ChinaDepartment of Pathology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, ChinaDepartment of Pathology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, ChinaDepartment of Nephrology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, ChinaDepartment of Nephrology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, ChinaDepartment of Nephrology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, ChinaDepartment of Nephrology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, ChinaAbstractBackground Cyclophosphamide (CTX) and calcineurin inhibitors (CNIs) based regimens are recommended as immunosuppressive therapies for patients with idiopathic membranous nephropathy (IMN). Focal and segmental glomerular sclerosis (FSGS) lesions, which are common in membranous nephropathy (MN), are poor predictors of outcome. This study compared the differences of prognosis between two regimens in patients with IMN combined with FSGS lesions.Methods This retrospective study enrolled 108 patients with biopsy-proven IMN, accompanied with FSGS lesions, nephrotic syndrome and an estimated glomerular filtration rate (eGFR)≥60 mL/min/1.73 m2 who were treated with CTX or CNIs. We used propensity score matching (PSM) for balancing the confounding variables.Results During follow-up, 10 patients (10/55 [18.2%]; nine males) in the CNIs group showed a 50% decline in eGFR; eight had a not otherwise specified variant. Patients initially treated with CNIs had a significantly higher risk of progression to the primary outcome and a lower probability of complete or total remission. The relapse rate was higher in patients who initially received CNIs- than in those who received CTX-based treatment. Before PSM, age and 24-h urine protein level differed significantly between the groups. The PSM model included data from 72 patients. Worse outcomes were also noted among patients who initially received CNIs than those who received CTX-based treatments after matching.Conclusions Patients with MN combined with FSGS lesions have a higher risk of renal functional decline and a higher rate of relapse after CNIs than after CTX therapy.https://www.tandfonline.com/doi/10.1080/0886022X.2023.2253930Membranous nephropathycyclophosphamidecalcineurin inhibitorsfocal and segmental glomerular sclerosisprognosis |
| spellingShingle | Hong-Guang He Yi-Yun Huang Qin-Qing Liang Qiu-Rong Ye An-Dong Li Kun Ye Qiu-Xia Wu Yan-Wu You Calcineurin inhibitors or cyclophosphamide in the treatment of membranous nephropathy superimposed with FSGS lesions: a retrospective study from China Renal Failure Membranous nephropathy cyclophosphamide calcineurin inhibitors focal and segmental glomerular sclerosis prognosis |
| title | Calcineurin inhibitors or cyclophosphamide in the treatment of membranous nephropathy superimposed with FSGS lesions: a retrospective study from China |
| title_full | Calcineurin inhibitors or cyclophosphamide in the treatment of membranous nephropathy superimposed with FSGS lesions: a retrospective study from China |
| title_fullStr | Calcineurin inhibitors or cyclophosphamide in the treatment of membranous nephropathy superimposed with FSGS lesions: a retrospective study from China |
| title_full_unstemmed | Calcineurin inhibitors or cyclophosphamide in the treatment of membranous nephropathy superimposed with FSGS lesions: a retrospective study from China |
| title_short | Calcineurin inhibitors or cyclophosphamide in the treatment of membranous nephropathy superimposed with FSGS lesions: a retrospective study from China |
| title_sort | calcineurin inhibitors or cyclophosphamide in the treatment of membranous nephropathy superimposed with fsgs lesions a retrospective study from china |
| topic | Membranous nephropathy cyclophosphamide calcineurin inhibitors focal and segmental glomerular sclerosis prognosis |
| url | https://www.tandfonline.com/doi/10.1080/0886022X.2023.2253930 |
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