Evaluation of Tacrolimus Combined With Corticosteroids vs Modified Ponticelli Regimen as Treatments for Refractory Primary Membranous Nephropathy
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2018-11
Autores
Navarro-Quiroz, Elkin
Aroca-Martinez, Gustavo
Domínguez-Vargas, Alex
Alonso-López, María José
Alvarado-Echeverría, Rebeca
Navarro-Quiroz, Roberto
Silva-Díaz, Diana
Gomez Escorcia, Lorena
González-Tórres, Henry J.
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Canadian Center of Science and Education
Resumen
Objective: To evaluate the immunosuppressive treatment response to modified Ponticelli regimen (MPR) and oral
corticosteroid (OC) plus tacrolimus (TAC) in patients with primary membranous nephropathy (PMN).
Methods: Retrospective cohort analytical study. Adults patients (>18 years old) with diagnosis of refractory PMN
(>50% increase in serum creatinine or a level >1.5mg/dl or proteinuria refractory to 6 months of supportive
treatment), proved by renal biopsy and immunofluorescence between 2008 and 2016 from the Nephropathy
Registry of Colombia (NEFRORED©) were included. Immunosuppressive treatment response was evaluated
from baseline to 6 months after the start of therapy.
Results: 128 patients with PMN were included, of which 74 (57%) were female. The most frequent syndromic
diagnosis was nephrotic syndrome 90 (70%), followed by asymptomatic urinary disorders 31 (25%). Chronic
kidney disease manifested concomitantly in 7 (5%) patients. At the end of 6 months, 86 (67%) cases achieved
some degree of remission: 23 (18%) complete response (CR) and 63 (49%) cases with partial response (PR), while
42 (33%) cases did not achieved remission. In the TAC+OC group, CR and PR were seen in 14 (20%) and 33 (47%)
patients, respectively; and 9 (16%) and 30 (51%) patients in the MPR group, respectively. No statistically
significant differences were found when comparing the immunosuppressive treatment response rate with both
treatment groups (p > 0.05).
Conclusions: In the PMN, both immunosuppressive treatments (TAC+OC vs MPR) are comparable. We suggest a
clinical follow-up of the anti-PLA2R/THSD7A titres at 6/12 months to be correlated with renal function in
subsequent studies.
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Palabras clave
Primary membranous nephropathy, Modified Ponticelli regimen, Immunosuppressive therapy, Tacrolimus