Yang Hongyu, Sun Guangping, Yang Xu, Luan Junjun, Jiao Congcong, Song Qinglei, Du Feng, Zhang Beiru, Wang Yanqiu, Kopp Jeffrey B, Zhou Hua
Department of Nephrology, Shengjing Hospital of China Medical University, Shenyang, China.
Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases/National Institutes of Health, Bethesda, Maryland, USA.
Kidney Int Rep. 2024 Sep 21;9(12):3446-3454. doi: 10.1016/j.ekir.2024.09.016. eCollection 2024 Dec.
Kidney Disease Improving Global Outcomes guidelines indicate that glucocorticoids and immunosuppressants comprise the first therapeutic regimens after 4 to 6 months of treatment for high-risk primary membranous nephropathy (PMN). However, some patients cannot achieve complete or partial remission at 6 months. This study aimed to evaluate the efficacy of traditional immunotherapy combined with hydroxychloroquine (HCQ), a well-known immune regulator, in patients with PMN.
This was a single-center, open-label, prospective study. We recruited 72 patients with nephrotic syndrome and PMN proven by renal biopsy from May 2020 to June 2024. We compared changes in proteinuria, serum albumin levels, estimated glomerular filtration rate (eGFR), and relapse rate at 3, 6, 9, and 12 months follow-up in 41 patients who received glucocorticoid and immunosuppressant, and in 31 who received HCQ plus standard-of-care.
Baseline characteristics showed no statistical significance between the 2 groups. However, the HCQ group showed significantly reduced proteinuria compared to standard-of-care group. A reduced proteinuria was seen at 6 months (1.2 [0.4-2.2] vs. 2.2 [1.0-3.8] g/d, = 0.029) and the relapse rate with 12 months follow-up was also significantly decreased in the HCQ group compared to the standard-of-care group (3.7% vs. 23.3%, = 0.033).
HCQ may serve as an effective add-on therapy for PMN.
改善全球肾脏病预后组织（KDIGO）指南指出，对于高危原发性膜性肾病（PMN），糖皮质激素和免疫抑制剂是治疗4至6个月后的首选治疗方案。然而，一些患者在6个月时无法实现完全或部分缓解。本研究旨在评估传统免疫疗法联合知名免疫调节剂羟氯喹（HCQ）对PMN患者的疗效。
这是一项单中心、开放标签的前瞻性研究。我们从2020年5月至2024年6月招募了72例经肾活检证实为肾病综合征和PMN的患者。我们比较了41例接受糖皮质激素和免疫抑制剂治疗的患者以及31例接受HCQ加标准治疗的患者在3、6、9和12个月随访时蛋白尿、血清白蛋白水平、估计肾小球滤过率（eGFR）和复发率的变化。
两组的基线特征无统计学意义。然而，与标准治疗组相比，HCQ组的蛋白尿显著减少。在6个月时蛋白尿减少（1.2[0.4 - 2.2] vs. 2.2[1.0 - 3.8] g/d，P = 0.029），并且与标准治疗组相比，HCQ组在12个月随访时的复发率也显著降低（3.7% vs. 23.3%，P = 0.033）。
HCQ可能是PMN的一种有效附加疗法。
