Long-Term Efficacy of Treatment with Cyclosporine in Idiopathic Membranous Nephropathy: Remission Is Not Enough

Abstract

Background: Membranous nephropathy (MN) is an autoimmune disease in which circulating autoantibodies bind to a podocyte antigen, causing nephrotic syndrome. Despite several treatment options, their long-term benefits are still not established. The aim of this study is to investigate the long-term efficacy of cyclosporine and methylprednisolone in MN treatment. Methods: In this retrospective study, we included adults with biopsy-proven idiopathic MN. At diagnosis, all patients received conservative treatment, and those who did not show remission after 6 months received immunosuppression with cyclosporine and methylprednisolone. Those that despite no remission chose not to receive immunosuppression served as controls. Results: Sixty patients were included in the study with a follow-up of 94.8 ± 55.5 months. Forty-nine patients had nephrotic syndrome, and 47 received immunosuppression, while 13 received no treatment. Out of those who received immunosuppression, 63.8% showed complete, 14.9% partial, and 19.1% no remission of nephrotic syndrome. End-stage kidney disease (ESKD) or doubling of serum creatinine was reached by 12. Out of those who received no immunosuppression, 23.1% showed complete, 30.8% partial, and 23.1% had no remission. Doubling of serum creatinine or ESKD was reached by 1. Kidney survival was not altered by immunosuppression and was not different among those who received immunosuppression and had no or up to 3 relapses. Either complete or partial remission was accompanied by better kidney survival. Conclusion: Treatment of idiopathic MN with cyclosporine and methylprednisolone offers a reliable option for proteinuria remission. Nevertheless, this option does not alter long-term disease progression.