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Clinical Nephrology
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A Randomized, Controlled Trial of Steroids and Cyclophosphamide in Adults with Nephrotic Syndrome Caused by Idiopathic Membranous Nephropathy

Vivekanand Jha, Anirban Ganguli, Tarun K. Saha, Harbir S. Kohli, Kamal Sud, Krishan L. Gupta, Kusum Joshi and Vinay Sakhuja
JASN June 2007, 18 (6) 1899-1904; DOI: https://doi.org/10.1681/ASN.2007020166
Vivekanand Jha
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Anirban Ganguli
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Tarun K. Saha
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Harbir S. Kohli
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Kamal Sud
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Krishan L. Gupta
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Kusum Joshi
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Vinay Sakhuja
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Abstract

Idiopathic membranous nephropathy (IMN) is the most common cause of nephrotic syndrome in adults. Universal consensus regarding the need for and the modality of therapy has not been formed because of a lack of controlled trials of sufficient size, quality, and duration. This study compared the effect of a 6-mo course of alternating prednisolone and cyclophosphamide with supportive treatment in adults with nephrotic syndrome caused by IMN on doubling of serum creatinine, development of ESRD, and quality of life in a randomized, controlled trial. Patients were followed up for 10 yr. Data were analyzed on an intention-to-treat basis. A total of 93 patients completed the study. Of the 47 patients who received the experimental protocol, 34 achieved remission (15 complete and 19 partial), compared with 16 (five complete, 11 partial) of 46 in the control group (P < 0.0001). The 10-yr dialysis-free survival was 89 and 65% (P = 0.016), and the likelihood of survival without death, dialysis, and doubling of serum creatinine were 79 and 44% (P = 0.0006) in the two groups. Treated patients exhibited significantly lower prevalence of edema, hypertension, hypoalbuminemia, hyperlipidemia that required therapy, angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker use, and better quality of life on follow-up. The incidence of infections was similar in the two groups. In conclusion, untreated IMN with nephrotic syndrome is associated with a high risk for deterioration of renal function. A 6-mo regimen of cyclophosphamide and steroids induces remissions in a high proportion, arrests progression of renal insufficiency, and improves quality of life.

  • © 2007 American Society of Nephrology
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Journal of the American Society of Nephrology: 18 (6)
Journal of the American Society of Nephrology
Vol. 18, Issue 6
June 2007
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A Randomized, Controlled Trial of Steroids and Cyclophosphamide in Adults with Nephrotic Syndrome Caused by Idiopathic Membranous Nephropathy
Vivekanand Jha, Anirban Ganguli, Tarun K. Saha, Harbir S. Kohli, Kamal Sud, Krishan L. Gupta, Kusum Joshi, Vinay Sakhuja
JASN Jun 2007, 18 (6) 1899-1904; DOI: 10.1681/ASN.2007020166

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A Randomized, Controlled Trial of Steroids and Cyclophosphamide in Adults with Nephrotic Syndrome Caused by Idiopathic Membranous Nephropathy
Vivekanand Jha, Anirban Ganguli, Tarun K. Saha, Harbir S. Kohli, Kamal Sud, Krishan L. Gupta, Kusum Joshi, Vinay Sakhuja
JASN Jun 2007, 18 (6) 1899-1904; DOI: 10.1681/ASN.2007020166
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  • Rituximab versus steroids and cyclophosphamide for the treatment of primary membranous nephropathy: protocol of a pilot randomised controlled trial
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  • Balancing Cancer Risk and Efficacy of Using Cyclophosphamide to Treat Idiopathic Membranous Nephropathy
  • Glomerular Diseases: Membranous Nephropathy--A Modern View
  • Long-Term Outcomes in Idiopathic Membranous Nephropathy Using a Restrictive Treatment Strategy
  • Immunosuppression for Membranous Nephropathy: A Systematic Review and Meta-Analysis of 36 Clinical Trials
  • Treatment of Idiopathic Membranous Nephropathy
  • Rituximab in Idiopathic Membranous Nephropathy
  • Low-Molecular-Weight Proteins as Prognostic Markers in Idiopathic Membranous Nephropathy
  • Have We Changed the Outcome in Membranous Nephropathy? A Propensity Study on the Role of Immunosuppressive Therapy
  • Spontaneous Remission of Nephrotic Syndrome in Idiopathic Membranous Nephropathy
  • Rituximab Therapy for Membranous Nephropathy: A Systematic Review
  • Idiopathic Membranous Nephropathy: Diagnosis and Treatment
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