Liječnički vjesnik, Vol. 146 No. 5-6, 2024.
Original scientific paper
https://doi.org/10.26800/LV-146-5-6-2
Calcineurin inhibitors in treatment of membranous nephropathy – kidney function long term outcomes
Bojana Šimunov
*
Iva Canjuga Sever
Bojana Maksimović
Željka Jureković
Lada Zibar
Branislav Čingel
Ivan Marageta
Snježana Šulc
Ksenija Vučur Šimić
Mladen Knotek
Mario Laganović
* Corresponding author.
Abstract
Aim: Calcineurin inhibitors (CNI) are the mainstay treatment of membranous nephropathy (MN). Nephrotoxicity of CNI remains a concern and limits their use. We aimed to evaluate long-term outcomes of patients with MN treated with CNI alone or in combination with rituximab (RTX) compared to other regimens. Methods: We retrospectively reviewed patients with MN treated with CNI for at least two months and who had at least one year of follow-up. We compared them to patients treated with cyclophosphamide (CYC) or RTX alone without CNI. Results: There were in total 27 patients, 78,8% male, median age 54 years (IQR 43,5 – 59.5). At presentation 75.8% had nephrotic syndrome. Median follow-up time was 75 months (IQR 20.5 – 121.5). There were 19 patients in the CNI group, median age 48 years (IQR 39 – 55.5), 71.4% male, and eight patients who didn’t receive CNIs, median age 60 years (IQR 57 – 66), 75% male. There was no significant difference in aPLA2R positivity, 76.5% vs 50% respectively, p=0.359. No significant difference in change of eGFR at one year was detected, p=0.186. There was no significant difference in proteinuria at one year, p=0.275. At one year 89.5% patients were in full remission in the CNI group, vs 87.5% in the other group (p=0.663). Mean eGFR at last followup was 74.1±22.8mL/min/1.73m2 in the CNI group, and 72.3±18.1mL/min/1.73m2 in the group who hadn’t received CNIs (p=0.840). None of the patients in both groups had ESKD at last follow-up. Conclusion: CNIs present a safe and effective treatment of MN, both alone and as a part of combination regimens. Larger studies on longterm outcomes are needed to further evaluate our findings.
Keywords
GLOMERULONEPHRITIS, MEMBRANOUS – complications, drug therapy; NEPHROTIC SYNDROME – drug therapy, etiology; CALCINEURIN INHIBITORS – therapeutic use; RITUXIMAB – therapeutic use; CYCLOPHOSPHAMIDE – therapeutic use; RECEPTORS, PHOSPHOLIPASE A2 – immunology; AUTOANTIBODIES; GLOMERULAR FILTRATION RATE, PROTEINURIA; TREATMENT OUTCOME
Hrčak ID:
319958
URI
Publication date:
8.7.2024.
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