Ballarin José, Poveda Rafael, Ara Jordi, Pérez Laureà, Calero Francesca, Grinyó Josep M, Romero Ramón
Nephrology Department of Fundació Puigvert, Hospital Universitari de Bellvitge, Spain.
Nephrol Dial Transplant. 2007 Nov;22(11):3196-201. doi: 10.1093/ndt/gfm366. Epub 2007 Jun 25.
Membranous nephropathy is a common cause of nephrotic syndrome (NS) in adults. Its treatment is still under debate.
We report our experience in a pilot study using initially low doses of steroids and tacrolimus (Tac). After 3 months of treatment, mycophenolate mofetil (MMF) was added if the proteinuria was higher than 1 g/day.
In accordance with this standard, 21 patients entered the study. A proteinuria level lower than 1 g/day was reached at month 3 of therapy with steroids and Tac in 11 patients. These patients continued this treatment for 12 months. MMF was added in nine cases after the third month and triple therapy was maintained for 12 more months. Two patients were withdrawn because of side effects. At the end of the treatment, remission of the NS was present in 15 out of all the patients (71.4%). Remission of the NS was complete in eight (53.3%) patients and partial in seven (46.7%) others. The remaining four patients did not respond. There were no significant changes in renal function. At a mean time of 23.1 months after treatment was discontinued, 11 (73.3%) patients had relapsed.
In this trial, treatment with tacrolimus showed a good efficacy but a high relapse rate when it was discontinued.
膜性肾病是成人肾病综合征（NS）的常见病因。其治疗仍存在争议。
我们报告了一项初步研究的经验，该研究最初使用低剂量的类固醇和他克莫司（Tac）。治疗3个月后，如果蛋白尿高于1g/天，则加用霉酚酸酯（MMF）。
按照该标准，21例患者进入研究。11例患者在使用类固醇和Tac治疗的第3个月时蛋白尿水平低于1g/天。这些患者继续该治疗12个月。9例患者在第3个月后加用MMF，并维持三联治疗12个月。2例患者因副作用退出。治疗结束时，所有患者中有15例（71.4%）达到NS缓解。8例（53.3%）患者完全缓解，7例（46.7%）部分缓解。其余4例患者无反应。肾功能无显著变化。在停药后的平均23.1个月时，11例（73.3%）患者复发。
在该试验中，他克莫司治疗显示出良好的疗效，但停药后复发率较高。
