Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland).
Department of Nephrology, Guangxi Minzu Hospital, The Affiliated Minzu Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland).
Med Sci Monit. 2021 Apr 26;27:e930500. doi: 10.12659/MSM.930500.
BACKGROUND Tacrolimus may be effective in the short-term treatment of idiopathic membranous nephropathy (IMN). However, it is not clear whether an electron microscopic classification of the homogeneous and heterogeneous types of nephrotic IMN is related to the efficacy of tacrolimus in patients with IMN. This study aimed to explore this question and to provide evidence for individualized patient treatment. MATERIAL AND METHODS This 6-month retrospective study included 61 Chinese patients previously diagnosed with IMN. Patients received treatment was tacrolimus plus glucocorticoid. The patients were divided into a homogeneous group and a heterogeneous group based on the evaluation of electron-dense deposits. The initial clinicopathologic factors in the 2 groups were analyzed, and the difference in efficacy of tacrolimus in the 2 groups was assessed. The factors predicting remission were also studied. RESULTS No significant alteration in the initial clinicopathologic status was found between the 2 groups, except for proteinuria, serum albumin levels, systolic blood pressure, and renal biopsy results (stages I/II/III/IV). After 3 months of treatment, the difference in remission was not significant between the 2 groups. However, after 6 months of treatment, a significant difference in remission rates was observed between the 2 groups. The binary logistic model showed that the homogeneous nephrotic IMN was independently associated with total remission (partial plus complete remission), and was also related to complete remission. CONCLUSIONS The results of our study revealed that the homogeneous type of nephrotic IMN had a higher short-term remission rate and a predictive value for partial or complete remission, and it might be a meaningful marker of the short-term response to tacrolimus.
他克莫司可能对特发性膜性肾病（IMN）的短期治疗有效。然而，肾病性 IMN 的均一型和非均一型的电子显微镜分类是否与 IMN 患者使用他克莫司的疗效相关尚不清楚。本研究旨在探讨这一问题，为患者的个体化治疗提供依据。
本 6 个月的回顾性研究纳入了 61 例先前被诊断为 IMN 的中国患者。患者接受他克莫司联合糖皮质激素治疗。根据电子致密物沉积的评估，将患者分为均一型组和非均一型组。分析两组患者的初始临床病理因素，并评估两组患者使用他克莫司的疗效差异。同时研究预测缓解的因素。
两组患者的初始临床病理状态除蛋白尿、血清白蛋白水平、收缩压和肾活检结果（I/II/III/IV 期）外，无明显变化。治疗 3 个月后，两组缓解率无显著差异。然而，治疗 6 个月后，两组缓解率差异显著。二元逻辑模型显示，均一型肾病性 IMN 与完全缓解（部分缓解加完全缓解）独立相关，也与完全缓解相关。
本研究结果表明，肾病性 IMN 的均一型具有较高的短期缓解率和部分或完全缓解的预测价值，可能是他克莫司短期疗效的有意义标志物。
