Advertisement

Clinical Drug Investigation

, Volume 16, Issue 3, pp 211–218 | Cite as

Immunosuppressive Treatment for Idiopathic Nephrotic Syndrome with Corticosteroids and Cyclophosphamide

Factors Associated with a Favourable Outcome
  • Mario Pirisi
  • Rossana Faedda
  • Andrea Satta
  • Ettore Bartoli
Clinical Use

Abstract

Objective: We report the results of a combined immunosuppressive schedule for the treatment of patients with idiopathic nephrotic syndrome, in which prednisone and cyclophosphamide were given in four phases: induction, maintenance, tapering and discontinuation.

Patients and Outcome Measures: Sixty-seven patients with nephrotic syndrome, followed for an average of 7.1 ± 4.5 years, were studied. Treatment outcomes were remission, progression, end-stage renal disease and death.

Results: At the end of the follow-up, 72% of patients maintained a complete remission. Stepwise logistic regression showed that the cumulative dose of cyclophosphamide was the only independent predictor of a favourable outcome, being associated both with complete remission of the nephrotic syndrome and with lack of progression to chronic renal failure.

Conclusion: We suggest that the combination treatment may be indicated in all histological subgroups of nephrotic syndrome, provided that prednisone is given at high doses on alternate days, cyclophosphamide is given for 6 months, and relapses are treated with the same schedule. The adverse effects of treatment, however, require the adoption of a programme to prevent bone loss, infertility, bladder cancer and infections.

Keywords

Adis International Limited Nephrotic Syndrome Chronic Renal Failure Plasma Creatinine Azoospermia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Glassock RJ, Adler SG, Ward HJ, et al. Primary glomerular diseases. In: Brenner BM, Rector Jr FC, editors. The Kidney. 4th ed. Philadelphia: Saunders, 1991: 1182–279Google Scholar
  2. 2.
    Diamond JR, Karnovski MJ. Focal and segmental glomerulo-sclerosis: analogies to atherosclerosis. Kidney Int 1988; 33: 917–24PubMedCrossRefGoogle Scholar
  3. 3.
    Wilson CB. The renal response to immunologic injury. In: Brenner BM, Rector Jr FC, editors. The Kidney. 4th ed. Philadelphia: Saunders, 1991: 1062–181Google Scholar
  4. 4.
    Schena FP, Cameron JS. Treatment of proteinuric idiopathic glomerulonephritides in adults: a retrospective survey. Am J Med 1988; 85: 315–26PubMedCrossRefGoogle Scholar
  5. 5.
    Churg J, Habib R, White RHR. Pathology of the nephrotic syndrome in children. A report for the International Study of Kidney Disease in Children. Lancet 1970; I: 1299–302CrossRefGoogle Scholar
  6. 6.
    International Study of Kidney Disease in Children. Primary nephrotic syndrome in children: clinical significance of histopathologic variants of minimal change and of diffuse mesangial hypercellularity. Kidney Int 1981; 20: 765–71CrossRefGoogle Scholar
  7. 7.
    Lewis EJ. Chlorambucil for childhood nephrosis. A word of caution. N Engl J Med 1980; 302: 963–4PubMedCrossRefGoogle Scholar
  8. 8.
    Orth SR, Ritz E. The nephrotic syndrome. N Engl J Med 1998; 338: 1202–11PubMedCrossRefGoogle Scholar
  9. 9.
    Faedda R, Satta A, Bosincu L, et al. Immune suppressive treatment of membranous glomerulonephritis. J Nephrol 1995; 8: 107–12Google Scholar
  10. 10.
    Faedda R, Satta A, Tanda F, et al. Immunosuppressive treatment of membranoproliferative glomerulonephritis. Nephron 1994; 67: 59–65PubMedCrossRefGoogle Scholar
  11. 11.
    Faedda R, Satta A, Tanda F, et al. Immunesuppressive treatment of nephrotic syndrome due to mesangial lesions. Clin Nephrol 1996; 46: 237–44PubMedGoogle Scholar
  12. 12.
    Alexopoulos E, Sakellariou G, Memmos D, et al. Cyclophosphamide provides no additional benefit to steroid treatment in the treatment of idiopathic membranous nephropathy. Am J Kidney Dis 1993; 21: 497–503PubMedGoogle Scholar
  13. 13.
    Bruns FJ, Adler S, Fraley DS, et al. Sustained remission of membranous glomerulonephritis after cyclophosphamide and prednisone. Ann Intern Med 1991; 114: 725–30PubMedGoogle Scholar
  14. 14.
    Schieppati A, Mosconi L, Perna A, et al. Prognosis of untreated patients with idiopathic membranous nephropathy. N Engl J Med 1993; 329: 85–9PubMedCrossRefGoogle Scholar
  15. 15.
    Faedda R, Palomba D, Satta A, et al. Immunosuppressive treatment of the glomerulonephritis of systemic lupus. Clin Nephrol 1995; 44: 367–75PubMedGoogle Scholar
  16. 16.
    Earley LE, Havel RJ, Hopper Jr J, et al. Nephrotic syndrome. Calif Med 1971; 115: 23–41PubMedGoogle Scholar
  17. 17.
    Samrook P, Birmingham RN, Kelly P, et al. Prevention of corticosteroid osteoporosis. N Engl J Med 1993; 328: 1747–52CrossRefGoogle Scholar
  18. 18.
    Boumpas DT, Austin HA, Vaughan EM, et al. Risk for substained amenorrhea in patients with systemic lupus erythematosus receiving intermittent pulse cyclophosphamide therapy. Ann Intern Med 1993; 119: 366–9PubMedGoogle Scholar
  19. 19.
    Masala A, Faedda R, Alagna S, et al. Use of testosterone to prevent cyclophosphamide-induced azoospermia. Ann Intern Med 1997; 126: 292–5PubMedGoogle Scholar
  20. 20.
    Levine EG, Bloomfield CD. Leukemias and myelodisplastic syndromes secondary to drug, radiation and environmental exposure. Semin Oncol 1992; 19: 47–84PubMedGoogle Scholar
  21. 21.
    Pedersen-Bjergaard J, Specht L, Larsen SO, et al. Risk of therapy-related leukaemia and preleukaemia after Hodgkin’s disease. Lancet 1987; II: 83–8CrossRefGoogle Scholar
  22. 22.
    Pedersen-Bjergaard J, Ersboll J, Mygind Sorensen H, et al. Risk of acute nonlymphocytic leukemia and preleukemia in patients treated with cyclophosphamide for non-Hodgkin lymphomas. Ann Int Med 1985; 103: 195–200PubMedGoogle Scholar
  23. 23.
    Zarrabi MH. Association of non-Hodgkin’s lymphoma and second neoplasms. Semin Oncol 1990; 17: 120–32PubMedGoogle Scholar
  24. 24.
    Lee JC, Yamauchi H, Hopper Jr J. The association of cancer and the nephrotic syndrome. Ann Intern Med 1966; 64: 41–51PubMedGoogle Scholar
  25. 25.
    Faedda R, Pirisi M, Satta A, et al. Immunosuppressive treatment of Berger’s disease. Clin Pharmacol Ther 1996; 60: 561–7PubMedCrossRefGoogle Scholar
  26. 26.
    Faedda R, Pirisi M, Satta A, et al. Regression of HenochSchönlein disease with intensive immunosuppressive treatment. Clin Pharmacol Ther 1996; 60: 567–81Google Scholar
  27. 27.
    Honkanen E, von Willebrand E, Teppo AM, et al. Adhesion molecules and urinary tumor necrosis factor-alpha in idiopathic membranous glomerulonephritis. Kidney Int 1998; 53: 909–17PubMedCrossRefGoogle Scholar
  28. 28.
    Fujimoto S, Yamamoto Y, Hisanaga S, et al. Minimal change nephrotic syndrome in adults: response to corticosteroid therapy and frequency of relapse. Am J Kidney Dis 1991; 17: 687–92PubMedGoogle Scholar
  29. 29.
    Curry RC, Roberts WC. Status of the coronary arteries in the nephrotic syndrome. Analysis of 20 necropsy patients aged 15 to 35 years to determine if coronary atherosclerosis is accelerated. Am J Med 1977; 63: 183–92PubMedCrossRefGoogle Scholar
  30. 30.
    Sheil AGR, Flavel S, Disney APS, et al. Cancer in dialysis and transplant patients. Transplant Proc 1985; 17: 195–8Google Scholar
  31. 31.
    Penn I. Neoplastic consequences of transplantation and chemotherapy. Cancer Det Prev 1987; 9Suppl. 1: 149–57Google Scholar
  32. 32.
    Abbate M, Remuzzi G. Innovative strategies for pharmacological intervention in immune damage to the kidney. Nephrol Dial Transplant 1995; 10: 1131–6PubMedGoogle Scholar

Copyright information

© Adis International Limited 1998

Authors and Affiliations

  • Mario Pirisi
    • 1
  • Rossana Faedda
    • 2
  • Andrea Satta
    • 2
  • Ettore Bartoli
    • 1
  1. 1.Cattedra di Medicina Interna, DPMSCUniversità degli StudiUdineItaly
  2. 2.Istituto di Patologia MedicaUniversità degli StudiSassariItaly

Personalised recommendations