Idiopathic Membranous Nephropathy and Treatment Related Complications
| Autor: | Snezana Uncanin, Alma Muslimović, Jasminka Dzemidzić, Denis Hasković, Nafija Serdarevic |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Male
Membranous nephropathy medicine.medical_specialty medicine.drug_class medicine.medical_treatment Anti-Inflammatory Agents 030232 urology & nephrology Renal function Low molecular weight heparin Case Report Spontaneous remission Disease 030204 cardiovascular system & hematology Glomerulonephritis Membranous Methylprednisolone 03 medical and health sciences 0302 clinical medicine Internal medicine Humans Medicine pulmonary thromboembolism Antineoplastic Agents Alkylating Ponticelli’s protocol Proteinuria business.industry Insulin Anticoagulants General Medicine Middle Aged medicine.disease Hyperglycemia Prednisone Chlorambucil Drug Therapy Combination medicine.symptom Pulmonary Embolism business Nephrotic syndrome |
| Zdroj: | Medical Archives |
| ISSN: | 0350-199X |
| DOI: | 10.5455/medarh.2020.74.228-232 |
| Popis: | Introduction Idiopathic Idiopathic membranous nephropathy (iMN) is an immune-complex mediated renal disease which is usually associated with the nephrotic syndrome (NS). The course of the disease is variable. Some patients maintain normal kidney function with or without a spontaneous remission of proteinuria, while others progress to end-stage renal failure or die from complications related to the nephrotic syndrome. Whether or not to treat a patient with idiopathic membranous nephropathy is still controversial. The controversy is mainly related to the toxicity of the therapy and the variable natural course of the disease-spontaneous remission occurs in 40-50% of patients. Aim The aim of this study was to describe our experience of treatment of an idiopathic membranous nephropathy (iMN), efficacy and complications rate. Case report Our patient was older, mail gender, in high-risk group with persistent proteinuria 10,68 g/day and stable renal function. We have taken these factors into consideration, along with age and other comorbidities, that may significantly elevate the risk of treatment. We chose to start with early treatment, following the Ponticelli's group protocol based on high dose corticosteroids (odd months) alternating with clorambucil (even months) for six months. This treatment was accompanied by the steroid side effects, including hyperglycaemia dependance on insulin therapy and pulmonary thromboembolism despite administered prophylactically low molecular weight heparin. The six-month treatment was successfully completed with the reduction of proteinuria to nephritic values 2,86 g/day, despite many complications. Complete remission of the disease with non-significant proteinuria and with stable renal function was achieved in 14 months which has been maintained for 2 years. Conclusion We suggest that decisions on the timing of start of therapy, whom to treat, best sequence of the use of the various immunosuppressive drugs must be based on an individualized assessment of risks and benefits. |
| Databáze: | OpenAIRE |
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