Zhou Houan, Li Manna, Zeng Caihong, Chen Zhaohong, Zhang Ti, Cheng Zhen
National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
Jinling Hospital, Nanjing Medical University, Nanjing, China.
Kidney Int Rep. 2022 Aug 8;7(10):2166-2175. doi: 10.1016/j.ekir.2022.07.009. eCollection 2022 Oct.
Immunomodulatory drugs (IMiDs) plus dexamethasone are effective for plasma cell dyscrasias, but the treatment efficacy of IMiD in proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID) has been rarely reported.
We retrospectively analyzed the clinicopathologic data of 64 patients with PGNMID (steroid, IMiD, and bortezomib and dexamethasone/Rituximab [BD/RTX] groups) from January 1, 2010 to December 31, 2020, at the National Clinical Research Center of Kidney Disease in Nanjing. The prognosis of patients receiving different treatment regimens were compared. Factors potentially affecting renal prognosis and renal response were evaluated.
Twenty-eight, 26 and 10 PGNMID patients were divided into IMiD group, steroid group and BD/RTX group respectively. The rate of serum M protein detection was significantly lower in the steroid group than in the other 2 groups. Renal remission ( = 0.001 and = 0.03, respectively) rates and renal complete remission (CR) ( = 0.001 and = 0.01, respectively) rates were significantly higher in the IMiD and BD/RTX groups than in the steroid group at the last follow-up. Multivariate logistic analysis identified that hypertension and high serum creatinine (SCr) levels (>1.24 mg/dl) decreased renal remission, whereas low C3 levels, IMiD and BD/RTX treatments were positively associated with renal remission. Multivariate Cox analysis identified IgG3 in renal tissue and high SCr levels as poor renal prognostic indicators. Severe adverse events were more common in the IMiD and BD/RTX groups than in the steroid group ( = 0.072 and = 0.035, respectively).
Our results suggest that IMiDs plus dexamethasone is effective for achieving renal remission in PGNMID patients.
免疫调节药物（IMiDs）联合地塞米松对浆细胞异常增殖性疾病有效，但IMiD在伴有单克隆免疫球蛋白沉积的增殖性肾小球肾炎（PGNMID）中的治疗效果鲜有报道。
我们回顾性分析了2010年1月1日至2020年12月31日在南京国家肾脏疾病临床研究中心收治的64例PGNMID患者（分为类固醇、IMiD、硼替佐米与地塞米松/利妥昔单抗[BD/RTX]组）的临床病理资料。比较了接受不同治疗方案患者的预后情况。评估了可能影响肾脏预后和肾脏反应的因素。
28例、26例和10例PGNMID患者分别被分为IMiD组、类固醇组和BD/RTX组。类固醇组血清M蛋白检测率显著低于其他两组。在最后一次随访时，IMiD组和BD/RTX组的肾脏缓解率（分别为=0.001和=0.03）和肾脏完全缓解（CR）率（分别为=0.001和=0.01）显著高于类固醇组。多因素逻辑回归分析确定，高血压和高血清肌酐（SCr）水平（>1.24mg/dl）会降低肾脏缓解率，而低C3水平、IMiD和BD/RTX治疗与肾脏缓解呈正相关。多因素Cox分析确定肾组织中的IgG3和高SCr水平是不良肾脏预后指标。IMiD组和BD/RTX组的严重不良事件比类固醇组更常见（分别为=0.072和=0.035）。
我们的结果表明，IMiDs联合地塞米松对PGNMID患者实现肾脏缓解有效。
