Immunosuppressive Treatments for Idiopathic Membranous Nephropathy: A Pilot Study According to Histopathological Stages

Background: No scholar has explored whether immunosuppressive treatments at different histopathological stages are different for idiopathic membranous nephropathy (IMN).

Methods: From January 1, 2012, to January 1, 2018, all biopsy confirmed IMN cases treated with glucocorticoid (GC) plus cyclophosphamide (CTX) or GC were retrieved from the patients' medical records.

Results: The present study included 67 patients who received GC alone (31 with stage I, 30 with stage II and 6 with stage III) and 157 patients who received GC + CTX (77 with stage I, 66 with stage II and 14 with stage III). Primary efficacy assessments included achieving complete remission and remission. Secondary efficacy assessments included proteinuria, serum albumin and adverse events. GC + CTX group showed higher complete remission rates than the GC group after 6 and 12 months in patients with stage II IMN (22% vs 10%, P = 0.04 and 59% vs 17%, P < 0.001, respectively). However, the two groups showed no difference in stages I and III (29% vs 26%, P = 0.61, 71% vs 52%, P = 0.09 and 14% vs 17%, P = 0.81, 21% vs 17%, P = 0.88, respectively). The GC + CTX group suffered a higher rate of gastrointestinal symptoms than the GC group in stage I and a higher rate of abnormal liver function in stage II.

Conclusions: Treatment with GC + CTX was more effective than GC in treating patients with stage II IMN; however, the advantage of GC + CTX was not significant for patients with stage I and III IMN.