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NDT Advance Access published online on June 25, 2007
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfm366
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Treatment of idiopathic membranous nephropathy with the combination of steroids, tacrolimus and mycophenolate mofetil: results of a pilot study

José Ballarin, Rafael Poveda, Jordi Ara, Laureà Pérez, Francesca Calero, Josep M. Grinyó and Ramón Romero

Nephrology Departments of Fundació Puigvert, Hospital Universitari de Bellvitge, Hospital Germans Trias i Pujol and Hospital de Vic. Barcelona, Spain

Correspondence and offprint requests to: Jose Ballarin, Servicio de Nefrologia, Fundacion Puigvert, Universidad Autonoma de Barcelona, Cartagena 340, 08025 Barcelona. Email: jballarin{at}fundacio-puigvert.es



  Abstract

Background. Membranous nephropathy is a common cause of nephrotic syndrome (NS) in adults. Its treatment is still under debate.

Methods. We report our experience in a pilot study using initially low doses of steroids and tacrolimus (Tac). After 3 months of treatment, mycophenolate mofetil (MMF) was added if the proteinuria was higher than 1 g/day.

Results. In accordance with this standard, 21 patients entered the study. A proteinuria level lower than 1 g/day was reached at month 3 of therapy with steroids and Tac in 11 patients. These patients continued this treatment for 12 months. MMF was added in nine cases after the third month and triple therapy was maintained for 12 more months. Two patients were withdrawn because of side effects. At the end of the treatment, remission of the NS was present in 15 out of all the patients (71.4%). Remission of the NS was complete in eight (53.3%) patients and partial in seven (46.7%) others. The remaining four patients did not respond. There were no significant changes in renal function. At a mean time of 23.1 months after treatment was discontinued, 11 (73.3%) patients had relapsed.

Conclusions. In this trial, treatment with tacrolimus showed a good efficacy but a high relapse rate when it was discontinued.

Keywords: membranous nephropathy; treatment; steroids; tacrolimus; mycophenolate mofetil; association

Received for publication: 20.11.06
Accepted in revised form: 11. 5.07


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