QJM, Vol 91, Issue 5 359-366, Copyright © 1998 by Oxford University Press
AJ Branten, LJ Reichert, RA Koene and JF Wetzels
We treated patients with idiopathic membranous nephropathy (iMGN) and renal
insufficiency, using: (i) (n = 15) monthly cycles of steroids (1 g
methyl-prednisolone i.v. on three consecutive days, followed by oral
prednisone 0.5 mg/kg/day months 1, 3 and 5) and chlorambucil (0.15
mg/kg/day months 2, 4 and 6); or (ii) (n = 17) oral cyclophosphamide
(1.5-2.0 mg/kg/day for 1 year) and steroids in a comparable dose. The
groups were comparable in age, renal function and levels of proteinuria.
During the 6 months preceding treatment, serum creatinine levels increased
from 148 +/- 50 to 219 +/- 73 mumol/l in the chlorambucil group and from
164 +/- 86 to 274 +/- 126 mumol/l in the cyclophosphamide group. Median
(range) follow-ups were: chlorambucil 38 months (8-71); cyclophosphamide 26
months (5-68) (NS). Renal function improved in both groups, but the
improvement was short-lived in the chlorambucil group; 12 months after
starting treatment, mean serum creatinine was 6.3 mumol/l lower in the
chlorambucil group and 121 mumol/l lower in the cyclophosphamide group (p
< 0.01). Four chlorambucil-treated patients developed ESRD, and five
needed a second course of therapy, whereas only one
cyclophosphamide-treated patient developed ESRD (p < 0.05). Remissions
of proteinuria occurred more frequently after cyclophosphamide treatment
(15/17 vs. 5/15; p < 0.01). Side-effects necessitated interruption of
treatment in six patients on cyclophosphamide and in 11 on chlorambucil (p
< 0.05). In our patients, oral cyclophosphamide was better tolerated
than oral chlorambucil. The suggested greater efficacy of the oral
cyclophosphamide regimen needs to be ascertained by longer follow-up.
ORIGINAL PAPERS
Oral cyclophosphamide versus chlorambucil in the treatment of patients with membranous nephropathy and renal insufficiency
Department of Medicine, University Hospital Nijmegen, The Netherlands.
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