P227
A RETROSPECTIVE ANALYSIS OF PATIENTS WITH IDIOPATHIC
MEMBRANOUS NEPHROPATHY TREATED WITH STEROIDS AND
INTRAVENOUS CYCLOPHOSPHAMIDE
Robin Ramphul1, Raja Mohammed Kaja Kamal1, David Makanjuola1, Rebecca
Suckling1, Fiona E. Harris1, Bhrigu Raj Sood1.
1Renal Unit, St. Helier Hospital, Carshalton, Surrey, United Kingdom.
BACKGROUND:
The use of steroids and oral Cyclophosphamide in the modified Ponticelli regimen is a
recognised treatment for patients with idiopathic membranous nephropathy, however
the role of intravenous cyclophosphamide for this indication is poorly described. We
present our experience of intravenous cyclophosphamide as an alternative to oral
cyclophosphamide in 12 patients with idiopathic membranous nephropathy treated
between January 2003 and April 2012. The protocol is as follows:
Prednisolone - 40 mg/day for 30 days - months 1, 3 and 5
Cyclophosphamide - day 1 - Months 2, 4 and 6 (dose as shown in table).
Age (years)
<60
>60 and <70
>70
Creatinine (μmol/L)
<300
15 mg/kg
12.5 mg/kg
10 mg/kg
>300
12.5 mg/kg
10 mg/kg
7.5 mg/kg
METHODS:
Data on creatinine, albumin and urine protein to creatinine ratio (UPCR) were collected.
All patients included were followed-up for at least 6 months. Treatment failure was
defined as ESRD, doubling of serum creatinine, switch to, or introduction of alternative
immunosuppression. Complete remission (CR) was defined as a reduction in UPCR to
< 50 mg/mmol. Partial remission (PR) was defined as a reduction in UPCR to < 350
mg/mmol and a 50% or greater reduction in UPCR.
RESULTS:
There were 12 men, age 68yrs (range 37 – 79); 1 died within 12 months. 10 patients had
stable renal function, 2 doubled their serum creatinine and progressed to End Stage
Renal Disease (ESRD) after 24 months. The mean UPCR reduced over the course of
follow-up (mean UPCR at baseline = 1128.2 mg/mmol, 6 months = 849.2 mg/mmol, 12
months = 615.3 mg/mmol, 24 months = 93.5 mg/mmol). 2 patients achieved CR of
proteinuria and 3 had PR. 3 patients were switched to calcineurin inhibitor (CNI), 2
after 12 months and 1 after 18 months for worsening of UPCR - all 3 maintained stable
renal function.
CONCLUSIONS:
In our cohort of patients, the immunosuppressive regimen reduced the proteinuria and
stabilised the decline in renal function. This suggests that pulsed intravenous
Cyclophosphamide may be a viable alternative to oral Cyclophosphamide in the
treatment of idiopathic membranous nephropathy.