Die Therapie der membranösen Glomerulonephritis mit Cyclosporin A
Bäuerle, Alexander Lutz
Cyclosporine (CsA) in combination with corticosteroids has shown efficacy in primary membranous glomerulonephropathy (MG) in reducing proteinuria and remission of the nephrotic syndrome (NOS). Our hypothesis was that nephrotoxicity could be avoided by monitoring through levels (CO) and reducing total daily dose by single daily dose regimes. In this retrospective long term analysis we compared single daily dose (SDD) versus twice daily dose (TDD) regimes in patients with NOS and membranous nephropathy. Twelve patients (6 SDD vs. 6 TDD; mean age 65 SD 15 years) were treated with CsA (target through level 75 - 100 ng/ml) and a total dose of 200 mg per day (150 - 300) that is 2.74 mg/kg body weight (1.69 - 4.44) over more than 60 months. Complete remission of NOS was present in both groups after 60 months (SDD: proteinuria 8.6 g/l (4.2 - 10.9) to 0.4 g/l (0.1 - 0.7), p = 0.008, and TDD: 3.3 g/l (1.2 - 2.5) to 0.3 g/l (0.1 - 3.2), p = 0.029 (Friedman-test). There was no difference in final proteinuria between SDD 0.43 mg (0.06 - 0.07) and TDD 0.27 mg (0.0 - 3.19); Mann-Whitney-U-Test p = 0.394. Serum protein was significantly increased in both groups after two years and there was a trend in increasing cholesterol, with no differences between both groups. The increase of serum creatinine was significant in both groups SDD from 84 µmol/l (62 - 106) to 147 µmol/l (92 - 182), p = 0.002, and TDD from 93 µmol/l (70 - 103) to 105 µmol/l (71 - 138), p = 0.045, Friedman-test. However and contrasting to our hypothesis, the final serum creatinine was significantly higher in the single daily dose group as compared to the twice daily dose group. In conclusion, SDD and TDD CsA treatment is effective in treatment MG with NOS, however for long term treatment TDD dose should be preferred due to less nephrotoxicity.
Subject HeadingsArzneimitteldosis [GND]
Membranöse Glomerulonephritis [GND]
Glomerulonephritis; Therapy [MeSH]