Comparison Of Tacrolimus, Cyclophosphamide And Tripterygium Wilfordii Multiglycosides In Idiopathic Membranous Nephropathy

Objective:Idiopathic membranous nephropathy (IMN) is one of the major causes of adult-onset nephrotic syndrome. Among IMN patients about 30% to 40% develop end-stage renal disease within 15 years and 10 years. However, the management of IMN remains controversial. The aim of this study is to compare the efficacy and drug safety of common treatment in IMN—TAC combined with corticosteroid, CTX combined with corticosteroid, TWF combined with corticosteroid and TAC mono-therapy, and try to find a ideal treatment.Methods:We selected 144 patients with the treatment of either TAC, CTX, TWF combined with corticosteroid or TAC mono-therapy among patients who had suffered renal biopsy and confirmed as the onset idiopathic membranous nephropathy of the First Affiliated Hospital of Zhejiang University during 2002 to 2015. The following variables were measured at the beginning of the study and follow-up time points:serum creatinine (SCr, μmol/1), eGFR (EPI, ml/min/1.73 m2), urine protein to creatinine ratio (g/g), serum ALB (g/1), and serum uric acid (umol/1). Follow-up visits were scheduled at 1,2,3,6, 12,18,24,30and 36 months after receiving the treatment of immunosuppressant. The primary end point is the remission, complete remission, relapse, death and ESRD. The secondary end point is side effect and renal injury 。 Using SPSS22.0 for statistical analysis.Result:At the end of follow-up the remission rate of TAC combined with corticosteroid, CTX combined with corticosteroid, TWF combined with corticosteroid and TAC mono-therapy were 89% and 82%,92% and 81% (p=0.631), the complete remission rate were 74%,60%,70% and 63%(p=0.434). After 2 weeks of treatment, urinary protein creatinine ratio of CTX combined with corticosteroid group decreased slowest (combined with TWF combined with corticosteroid group (P= 0.000), TAC combined with corticosteroid group (P= 0.001) and TAC mono-therapy group (P= 0.004)). Besides, urinary creatinine ratio of TWF combined with corticosteroids group is lower than that of TAC combined with corticosteroid group (P= 0.001). After 2months of treatment, serum albumin of TAC (combined with corticosteroid*) group is higher than that of CTX combined with corticosteroid group (p=0.012*, p=0.009) and TWF combined with corticosteroid group (p=0.001*, p=0.001*). After 6 months of treatment, urinary protein creatinine ratio of TWF combined with corticosteroid group is lower than that of CTX combined with corticosteroid group (P= 0.012) and TAC mono-therapy group (P= 0.008).There is no significant difference of GFR among each group. Besides, comparing with baseline GFR, no difference between CTX combined with corticosteroid group (P=0.620) and TAC combined with corticosteroid group(P= 0.357), however, a obviously decrease shows in TWF combined with corticosteroid group (P= 0.002)and TAC mono-therapy group(P= 0.000).Conclusion:TAC combined with corticosteroid, CTX combined with corticosteroid, TWF combined with corticosteroid and TAC mono-therapy can improve the remission rate of idiopathic membranous nephropathy and play a role in delaying the decline of renal function. Comparing with other treatment CTX combined with corticosteroid have more side effects, but low recurrence rate. For young women, TAC mono-therapy show about 80% of remission rate and avoid Cushing appearance caused by long-term oral corticosteroid. TWF combined with corticosteroid can reduce urinary protein, on the other side it takes a long time to increase the serum albumin. Besides, the using of TWF among women of childbearing age need to be cautious.