Passerini Patrizia, Ponticelli Claudio
Istituto Recovero e Cura Carattere Scientifico, Ospedale Maggiore, Milano, Italy.
Semin Nephrol. 2003 Jul;23(4):355-61. doi: 10.1016/s0270-9295(03)00052-4.
Corticosteroids and cytotoxic agents have been studied widely in membranous nephropathy (MN). However, controlled studies with corticosteroids have not shown a clear benefit of these agents on the outcome of the disease. Some controlled trials reported that cytotoxic agents can reduce proteinuria significantly, but it was difficult to assess the efficacy of these drugs in protecting renal function because of the short follow-up period of the studies. Three randomized controlled trials showed that a 6-month treatment regimen based on corticosteroids and a cytotoxic agent, giving each for 1 month at a time in an alternating schedule, could favor remission of the nephrotic syndrome and protect renal function. Taken together, the results of these trials at the end of the follow-up period, 74% of the 174 treated patients were without nephrotic syndrome, 4 patients were on chronic dialysis, and 2 patients died. Good results with cytotoxic drugs, often associated with corticosteroids, also have been reported in progressive membranous nephropathy. However, in patients with renal insufficiency side effects were frequent and severe. Moreover, in most cases renal function improved but did not return to normal.
皮质类固醇和细胞毒性药物已在膜性肾病（MN）中得到广泛研究。然而，使用皮质类固醇的对照研究并未显示这些药物对疾病转归有明显益处。一些对照试验报告称，细胞毒性药物可显著降低蛋白尿，但由于研究随访期较短，难以评估这些药物在保护肾功能方面的疗效。三项随机对照试验表明，基于皮质类固醇和一种细胞毒性药物的6个月治疗方案，即二者交替每月使用1个月，可能有利于肾病综合征的缓解并保护肾功能。综合来看，在随访期末这些试验的结果显示，174例接受治疗的患者中，74%无肾病综合征，4例接受慢性透析，2例死亡。在进行性膜性肾病中也报告了细胞毒性药物（常与皮质类固醇联合使用）取得的良好效果。然而，肾功能不全的患者副作用频繁且严重。此外，在大多数情况下，肾功能有所改善但未恢复正常。
