Urology Clinic, University Clinical Center of Sarajevo, Sarajevo, Bosnia and Herzegovina and Clinic of Nephrology, Clinics Center, Sarajevo, Bosnia and Herzegovina.
Faculty of Health Studies, University of Sarajevo, Bosnia and Herzegovina.
Med Arch. 2020 Jun;74(3):228-232. doi: 10.5455/medarh.2020.74.228-232.
Idiopathic Idiopathic membranous nephropathy (iMN) is an immune-complex mediated renal disease which is usually associated with the nephrotic syndrome (NS). The course of the disease is variable. Some patients maintain normal kidney function with or without a spontaneous remission of proteinuria, while others progress to end-stage renal failure or die from complications related to the nephrotic syndrome. Whether or not to treat a patient with idiopathic membranous nephropathy is still controversial. The controversy is mainly related to the toxicity of the therapy and the variable natural course of the disease-spontaneous remission occurs in 40-50% of patients.
The aim of this study was to describe our experience of treatment of an idiopathic membranous nephropathy (iMN), efficacy and complications rate.
Our patient was older, mail gender, in high-risk group with persistent proteinuria 10,68 g/day and stable renal function. We have taken these factors into consideration, along with age and other comorbidities, that may significantly elevate the risk of treatment. We chose to start with early treatment, following the Ponticelli's group protocol based on high dose corticosteroids (odd months) alternating with clorambucil (even months) for six months. This treatment was accompanied by the steroid side effects, including hyperglycaemia dependance on insulin therapy and pulmonary thromboembolism despite administered prophylactically low molecular weight heparin. The six-month treatment was successfully completed with the reduction of proteinuria to nephritic values 2,86 g/day, despite many complications. Complete remission of the disease with non-significant proteinuria and with stable renal function was achieved in 14 months which has been maintained for 2 years.
We suggest that decisions on the timing of start of therapy, whom to treat, best sequence of the use of the various immunosuppressive drugs must be based on an individualized assessment of risks and benefits.
特发性膜性肾病（iMN）是一种免疫复合物介导的肾脏疾病，通常与肾病综合征（NS）相关。疾病的病程是多变的。一些患者的肾功能保持正常，蛋白尿可自发缓解或不缓解，而另一些患者则进展至终末期肾衰竭或死于与肾病综合征相关的并发症。是否治疗特发性膜性肾病仍存在争议。争议主要与治疗的毒性和疾病的多变自然病程有关-40-50%的患者会自发缓解。
本研究旨在描述我们治疗特发性膜性肾病（iMN）的经验、疗效和并发症发生率。
我们的患者年龄较大，为男性，属于高危人群，蛋白尿持续 10.68 克/天，肾功能稳定。我们考虑到了这些因素，以及年龄和其他合并症，这些因素可能显著增加治疗的风险。我们选择早期治疗，遵循 Ponticelli 小组的方案，即大剂量皮质类固醇（奇数月）与氯苯丁酸（偶数月）交替使用六个月。这种治疗伴有类固醇的副作用，包括依赖胰岛素治疗的高血糖和尽管预防性给予低分子肝素仍发生肺血栓栓塞。尽管存在许多并发症，但六个月的治疗成功地将蛋白尿减少到肾病值 2.86 克/天。
我们认为，关于开始治疗的时机、治疗对象、各种免疫抑制药物使用顺序的决策必须基于对风险和收益的个体化评估。
