Effect of steroid and cyclosporine in membranous nephropathy that is resistant to steroid and/or cytotoxic treatment.

Membranous Nephropathy (MN) is a glomerular disease characterized by proteinuria. The etiology is unknown in many cases, while in some patients MN may be secondary to infection, to other diseases, or to exposure to drugs and toxic substances. The prognosis of the disease is variable, 1/3 of patients can have spontaneous remission; patients with nephrotic proteinuria, those with advanced tubulointerstitial changes and those with increased serum creatinine at presentation have a poorer prognosis. Although MN is one of the most common causes of adult-onset Nephrotic Syndrome (NS), its management is still controversial. Corticosteroids have been used for many years as the basic treatment, though with controversial results. Controversial results have been obtained with cytotoxic agents. Cyclosporine has been shown to be effective in the treatment of this disease. We have evaluated the results of 23 patients (14 males, 9 females aged between 26-53) diagnosed with Idiopathic MN (IMN) who have received cyclosporine because of the relapse or persistence after steroid and/or cytotoxic treatment. At the end of a 12-month follow-up, 8 patients had (34.8%) complete remission, 8 (34.8%) had partial remission, 2 (8.7%) had persistent proteinuria and 5 patients (21.7%) had no response to the treatment. There was a significant decrease in proteinuria throughout the study. There was no significant difference in total protein, albumin and creatinine levels between before and after the treatment. Our results indicate that patients with MN who do not respond well or have-relapse after steroid and/or cytotoxic therapy, should be offered cyclosporine. We think that in the future; long-term studies which are prospective and randomized with an extensive number of patients will be effective on the treatment of MN.