SP145MODIFIED - ‘MODIFIED PONTICELLI REGIMEN’ - FOR IDIOPATHIC MEMBRANOUS NEPHROPATHY

Abstract

Introduction and Aims: Idiopathic membranous nephropathy (IMN) is a common cause of nephrotic syndrome in adults. There is no universal consensus regarding its therapy. Most favorable results have been obtained with cytotoxic agents given together with glucocorticoids (Ponticelli regimens). The concern in these regimens is their potential adverse effects. The aim of this study is to assess the effect of low dose pulse methyl prednisolone alternating with oral cyclophosphamide as a six month regimen in IMN. Methods: A retrospective study of five year duration(2010‐2014) was conducted on adults (>18 years) who had biopsy proven IMN and were treated with a drug protocol (Figure 1) which was a modification of 'the modified Ponticelli regimen'. Patients who were treated conservatively or with other therapy (cyclosporine) were excluded. Baseline clinical, biochemical and histopathological characteristics were collected. Outcomes and adverse effects of therapy at the end of 6 month and follow‐up data for one year were studied. Data was analyzed using SPSS version15. Results: Twenty seven patients received our regimen during study period. The baseline characteristics were shown in Table 1. All patients received either angiotensin converting enzyme inhibitors/ angiotensin receptor blockers as supportive therapy. The mean serum creatinine was 0.9 mg/dl and the median proteinuria was 6.6 gram per day. At the end of six months 25.9% had complete remission, 62.9% had partial remission and 11.1% had no response to therapy (table 2). The most common complications seen during the therapy were infections (35.7%) and steroid induced diabetes mellitus (37.5%). Leucopenia was seen with 8.3% of patients. On univariate analysis, the response to therapy was independent of either duration of the disease or degree of proteinuria. The relapse rate during follow‐up was 36.3% and the median time to relapse was six months. The limitations of our study are retrospective nature, lack of controls and short duration of followup. Conclusions: Use of low dose steroids and cyclophosphamide is effective in achieving remission in idiopathic membranous nephropathy. Further large randomized control trials with long term follow‐up are needed to confirm the same. (Figure presented).