Evaluation of Tacrolimus Combined With Corticosteroids vs Modified Ponticelli Regimen as Treatments for Refractory Primary Membranous Nephropathy
Objective: To evaluate the immunosuppressive treatment response to modified Ponticelli regimen (MPR) and oral corticosteroid (OC) plus tacrolimus (TAC) in patients with primary membranous nephropathy (PMN). Methods: Retrospective cohort analytical study. Adults patients (>18 years old) with diagn...
- Autores:
-
Navarro-Quiroz, Elkin
Aroca-Martinez, Gustavo
Domínguez-Vargas, Alex
Alonso-López, María José
Alvarado-Echeverría, Rebeca
Navarro-Quiroz, Roberto
Silva-Díaz, Diana
Gomez Escorcia, Lorena
González-Tórres, Henry J.
- Tipo de recurso:
- Fecha de publicación:
- 2018
- Institución:
- Universidad Simón Bolívar
- Repositorio:
- Repositorio Digital USB
- Idioma:
- eng
- OAI Identifier:
- oai:bonga.unisimon.edu.co:20.500.12442/2346
- Acceso en línea:
- http://hdl.handle.net/20.500.12442/2346
- Palabra clave:
- Primary membranous nephropathy
Modified Ponticelli regimen
Immunosuppressive therapy
Tacrolimus
- Rights
- License
- Licencia de Creative Commons Reconocimiento-NoComercial-CompartirIgual 4.0 Internacional
id |
USIMONBOL2_b27abf1eb641052c1d8eaa7429672209 |
---|---|
oai_identifier_str |
oai:bonga.unisimon.edu.co:20.500.12442/2346 |
network_acronym_str |
USIMONBOL2 |
network_name_str |
Repositorio Digital USB |
repository_id_str |
|
dc.title.eng.fl_str_mv |
Evaluation of Tacrolimus Combined With Corticosteroids vs Modified Ponticelli Regimen as Treatments for Refractory Primary Membranous Nephropathy |
title |
Evaluation of Tacrolimus Combined With Corticosteroids vs Modified Ponticelli Regimen as Treatments for Refractory Primary Membranous Nephropathy |
spellingShingle |
Evaluation of Tacrolimus Combined With Corticosteroids vs Modified Ponticelli Regimen as Treatments for Refractory Primary Membranous Nephropathy Primary membranous nephropathy Modified Ponticelli regimen Immunosuppressive therapy Tacrolimus |
title_short |
Evaluation of Tacrolimus Combined With Corticosteroids vs Modified Ponticelli Regimen as Treatments for Refractory Primary Membranous Nephropathy |
title_full |
Evaluation of Tacrolimus Combined With Corticosteroids vs Modified Ponticelli Regimen as Treatments for Refractory Primary Membranous Nephropathy |
title_fullStr |
Evaluation of Tacrolimus Combined With Corticosteroids vs Modified Ponticelli Regimen as Treatments for Refractory Primary Membranous Nephropathy |
title_full_unstemmed |
Evaluation of Tacrolimus Combined With Corticosteroids vs Modified Ponticelli Regimen as Treatments for Refractory Primary Membranous Nephropathy |
title_sort |
Evaluation of Tacrolimus Combined With Corticosteroids vs Modified Ponticelli Regimen as Treatments for Refractory Primary Membranous Nephropathy |
dc.creator.fl_str_mv |
Navarro-Quiroz, Elkin Aroca-Martinez, Gustavo Domínguez-Vargas, Alex Alonso-López, María José Alvarado-Echeverría, Rebeca Navarro-Quiroz, Roberto Silva-Díaz, Diana Gomez Escorcia, Lorena González-Tórres, Henry J. |
dc.contributor.author.none.fl_str_mv |
Navarro-Quiroz, Elkin Aroca-Martinez, Gustavo Domínguez-Vargas, Alex Alonso-López, María José Alvarado-Echeverría, Rebeca Navarro-Quiroz, Roberto Silva-Díaz, Diana Gomez Escorcia, Lorena González-Tórres, Henry J. |
dc.subject.eng.fl_str_mv |
Primary membranous nephropathy Modified Ponticelli regimen Immunosuppressive therapy Tacrolimus |
topic |
Primary membranous nephropathy Modified Ponticelli regimen Immunosuppressive therapy Tacrolimus |
description |
Objective: To evaluate the immunosuppressive treatment response to modified Ponticelli regimen (MPR) and oral corticosteroid (OC) plus tacrolimus (TAC) in patients with primary membranous nephropathy (PMN). Methods: Retrospective cohort analytical study. Adults patients (>18 years old) with diagnosis of refractory PMN (>50% increase in serum creatinine or a level >1.5mg/dl or proteinuria refractory to 6 months of supportive treatment), proved by renal biopsy and immunofluorescence between 2008 and 2016 from the Nephropathy Registry of Colombia (NEFRORED©) were included. Immunosuppressive treatment response was evaluated from baseline to 6 months after the start of therapy. Results: 128 patients with PMN were included, of which 74 (57%) were female. The most frequent syndromic diagnosis was nephrotic syndrome 90 (70%), followed by asymptomatic urinary disorders 31 (25%). Chronic kidney disease manifested concomitantly in 7 (5%) patients. At the end of 6 months, 86 (67%) cases achieved some degree of remission: 23 (18%) complete response (CR) and 63 (49%) cases with partial response (PR), while 42 (33%) cases did not achieved remission. In the TAC+OC group, CR and PR were seen in 14 (20%) and 33 (47%) patients, respectively; and 9 (16%) and 30 (51%) patients in the MPR group, respectively. No statistically significant differences were found when comparing the immunosuppressive treatment response rate with both treatment groups (p > 0.05). Conclusions: In the PMN, both immunosuppressive treatments (TAC+OC vs MPR) are comparable. We suggest a clinical follow-up of the anti-PLA2R/THSD7A titres at 6/12 months to be correlated with renal function in subsequent studies. |
publishDate |
2018 |
dc.date.accessioned.none.fl_str_mv |
2018-11-09T22:50:19Z |
dc.date.available.none.fl_str_mv |
2018-11-09T22:50:19Z |
dc.date.issued.none.fl_str_mv |
2018-11 |
dc.type.eng.fl_str_mv |
article |
dc.type.coar.fl_str_mv |
http://purl.org/coar/resource_type/c_6501 |
dc.identifier.issn.none.fl_str_mv |
19169744 |
dc.identifier.uri.none.fl_str_mv |
http://hdl.handle.net/20.500.12442/2346 |
identifier_str_mv |
19169744 |
url |
http://hdl.handle.net/20.500.12442/2346 |
dc.language.iso.eng.fl_str_mv |
eng |
language |
eng |
dc.rights.coar.fl_str_mv |
http://purl.org/coar/access_right/c_abf2 |
dc.rights.license.spa.fl_str_mv |
Licencia de Creative Commons Reconocimiento-NoComercial-CompartirIgual 4.0 Internacional |
rights_invalid_str_mv |
Licencia de Creative Commons Reconocimiento-NoComercial-CompartirIgual 4.0 Internacional http://purl.org/coar/access_right/c_abf2 |
dc.publisher.eng.fl_str_mv |
Canadian Center of Science and Education |
dc.source.eng.fl_str_mv |
Global Journal of Health Science |
dc.source.spa.fl_str_mv |
Vol. 10, No. 12 (2018) |
institution |
Universidad Simón Bolívar |
dc.source.uri.eng.fl_str_mv |
https://doi.org/10.5539/gjhs.v10n12p63 |
bitstream.url.fl_str_mv |
https://bonga.unisimon.edu.co/bitstreams/01d8e021-2e1f-48af-9441-fa6a05a963a1/download https://bonga.unisimon.edu.co/bitstreams/2c3626f8-ab6f-4bde-9ade-d50bc9480b1e/download https://bonga.unisimon.edu.co/bitstreams/ab3ca0f1-2b06-4e0b-a000-21db01339e89/download https://bonga.unisimon.edu.co/bitstreams/1366dd3a-1400-4916-a835-663d378b9190/download https://bonga.unisimon.edu.co/bitstreams/688b196f-13cc-49d7-8f02-632454cfcd04/download https://bonga.unisimon.edu.co/bitstreams/a85c0df1-bf94-41a4-95aa-10f99660c990/download |
bitstream.checksum.fl_str_mv |
10ca1e9e8e1d37ce8b9407335b70206f 3fdc7b41651299350522650338f5754d 613c6159195340ecee3220ddd8842e70 195fa3e37a2513c4271b2f30ef0b5629 faf91239c44c03af880447e217d28f80 04b41063053ecd6f7bb16e29fcf3a631 |
bitstream.checksumAlgorithm.fl_str_mv |
MD5 MD5 MD5 MD5 MD5 MD5 |
repository.name.fl_str_mv |
Repositorio Digital Universidad Simón Bolívar |
repository.mail.fl_str_mv |
repositorio.digital@unisimon.edu.co |
_version_ |
1814076097262780416 |
spelling |
Licencia de Creative Commons Reconocimiento-NoComercial-CompartirIgual 4.0 Internacionalhttp://purl.org/coar/access_right/c_abf2Navarro-Quiroz, Elkinb7f1ab18-ac07-40cf-9df1-f25f0c54e259-1Aroca-Martinez, Gustavo9ebd2f8e-91b1-462f-a15a-09db2a45ce2b-1Domínguez-Vargas, Alexd3599d9a-0024-4ac5-9bfb-269da6854041-1Alonso-López, María Joséd7046863-8766-4c98-aa12-25a7c3f675b8-1Alvarado-Echeverría, Rebecae8cde722-564f-43da-99e4-077807eacc41-1Navarro-Quiroz, Robertob6533240-1b1b-40e4-9123-44fefcab6c1e-1Silva-Díaz, Dianaf15ec347-7ae0-4ce3-885e-380fbc2da157-1Gomez Escorcia, Lorena0eda4380-18c9-49b2-b09c-a02809a7d505-1González-Tórres, Henry J.6cc190d7-4c94-4891-a17d-93f03066e94e-12018-11-09T22:50:19Z2018-11-09T22:50:19Z2018-1119169744http://hdl.handle.net/20.500.12442/2346Objective: To evaluate the immunosuppressive treatment response to modified Ponticelli regimen (MPR) and oral corticosteroid (OC) plus tacrolimus (TAC) in patients with primary membranous nephropathy (PMN). Methods: Retrospective cohort analytical study. Adults patients (>18 years old) with diagnosis of refractory PMN (>50% increase in serum creatinine or a level >1.5mg/dl or proteinuria refractory to 6 months of supportive treatment), proved by renal biopsy and immunofluorescence between 2008 and 2016 from the Nephropathy Registry of Colombia (NEFRORED©) were included. Immunosuppressive treatment response was evaluated from baseline to 6 months after the start of therapy. Results: 128 patients with PMN were included, of which 74 (57%) were female. The most frequent syndromic diagnosis was nephrotic syndrome 90 (70%), followed by asymptomatic urinary disorders 31 (25%). Chronic kidney disease manifested concomitantly in 7 (5%) patients. At the end of 6 months, 86 (67%) cases achieved some degree of remission: 23 (18%) complete response (CR) and 63 (49%) cases with partial response (PR), while 42 (33%) cases did not achieved remission. In the TAC+OC group, CR and PR were seen in 14 (20%) and 33 (47%) patients, respectively; and 9 (16%) and 30 (51%) patients in the MPR group, respectively. No statistically significant differences were found when comparing the immunosuppressive treatment response rate with both treatment groups (p > 0.05). Conclusions: In the PMN, both immunosuppressive treatments (TAC+OC vs MPR) are comparable. We suggest a clinical follow-up of the anti-PLA2R/THSD7A titres at 6/12 months to be correlated with renal function in subsequent studies.engCanadian Center of Science and EducationGlobal Journal of Health ScienceVol. 10, No. 12 (2018)https://doi.org/10.5539/gjhs.v10n12p63Primary membranous nephropathyModified Ponticelli regimenImmunosuppressive therapyTacrolimusEvaluation of Tacrolimus Combined With Corticosteroids vs Modified Ponticelli Regimen as Treatments for Refractory Primary Membranous Nephropathyarticlehttp://purl.org/coar/resource_type/c_6501Aldana, I., Diazgranados, I., Aroca, G., & García, R. (2014). Respuesta al esquema Ponticelli en pacientes con nefropatía membranosa idiopática. Barranquilla 2011-2013. Biociencias, 9(1), 23-29.Gaviria-García, G., Turizo, L., Orostegui, M., Suárez-Villa, M., Rivera-Julio, Y., Villalba, A., … Navarro-Díaz, L. (2015). Evaluacion del aprendizaje en enfermería: una mirada desde la asignatura del area profesional. In Educación: Una Mirada Desde La Comunicación, La Tecnología, La Investigación Y La Didactica (pp. 145-147). Colombia,: ed: Corporación Universitaria Americana.Sierra, C. (2017). Calidad de vida en pacientes con enfermedad renal crónica de una institución de salud. In Estudios actuales en Psicología . Perspectivas en Clinica y Salud (pp. 71-93. ISBN: 978-958-8930-68–8). Colombia: ed: Editorial Mejoras.Aroca-Martínez, G., Depine, S., Consuegra-Machado, J. R., González-Torres, H. J., Árquez-Mendoza, M., & Estrada-García, E. (2015). Development and use of an application programming interface modified from GoogleMaps© for the georeferencing of patients with glomerular disease. Nefrología : Publicación Oficial de La Sociedad Española Nefrologia, 35(1), 118-120. https://doi.org/10.3265/Nefrologia.pre2014.Oct.12736Cattran, D., & Brenchley, P. (2017). Membranous nephropathy: thinking through the therapeutic options. Nephrology Dialysis Transplantation, 32(suppl_1), i22-i29. https://doi.org/10.1093/ndt/gfw404Cattran, D. C., & Brenchley, P. E. (2017a). Membranous nephropathy: integrating basic science into improved clinical management. Kidney International, 91(3), 566-574. https://doi.org/10.1016/j.kint.2016.09.048Chen, M., Wang, H.-Y., Li, H., Li, X.-W., Li, X.-Y., Chen, J.-H., … Xu, F.-F. (2010). Tacrolimus Combined With Corticosteroids in Treatment of Nephrotic Idiopathic Membranous Nephropathy: A Multicenter Randomized Controlled Trial. The American Journal of the Medical Sciences, 339(3), 233-238. https://doi.org/10.1097/MAJ.0b013e3181ca3a7dCouser, W. G. (2017). Primary membranous nephropathy. Clinical Journal of the American Society of Nephrology, 12(6), 983-997. https://doi.org/10.2215/CJN.11761116Das, U., Dakshinamurty, K., & Prasad, N. (2009). Ponticelli regimen in idiopathic nephrotic syndrome. Indian Journal of Nephrology, 19(2), 48. https://doi.org/10.4103/0971-4065.53321De Vriese, A. S., Glassock, R. J., Nath, K. A., Sethi, S., & Fervenza, F. C. (2017). A Proposal for a Serology-Based Approach to Membranous Nephropathy. Journal of the American Society of Nephrology, 28(2), 421-430. https://doi.org/10.1681/ASN.2016070776Fervenza, F. C., Canetta, P. A., Barbour, S. J., Lafayette, R. A., Rovin, B. H., Aslam, N., … Cattran, D. C. (2015). A Multicenter Randomized Controlled Trial of Rituximab versus Cyclosporine in the Treatment of Idiopathic Membranous Nephropathy (MENTOR). Nephron, 130(3), 159-168. https://doi.org/10.1159/000430849Francis, J. M., Beck, L. H., & Salant, D. J. (2016). Membranous Nephropathy: A Journey From Bench to Bedside. American Journal of Kidney Diseases, 68(1), 138-147. https://doi.org/10.1053/j.ajkd.2016.01.030He, L., Peng, Y., Liu, H., Liu, Y., Yuan, S., Liu, F., … Fu, M. (2013). Treatment of idiopathic membranous nephropathy with combination of low-dose tacrolimus and corticosteroids. Journal of Nephrology, 26(3), 564-571. https://doi.org/10.5301/jn.5000199Lai, W. L., Yeh, T. H., Chen, P. M., Chan, C. K., Chiang, W. C., Chen, Y. M., … Tsai, T. J. (2015). Membranous nephropathy: A review on the pathogenesis, diagnosis, and treatment. Journal of the Formosan Medical Association, 114(2), 102-111. https://doi.org/10.1016/j.jfma.2014.11.002Ma, H., Sandor, D. G., & Beck, L. H. (2013). The Role of Complement in Membranous Nephropathy. Seminars in Nephrology, 33(6), 531-542. https://doi.org/10.1016/j.semnephrol.2013.08.004Ponticelli, C., Altieri, P., Scolari, F., Passerini, P., Roccatello, D., Cesana, B., … Bellazzi, R. (1998). A randomized study comparing methylprednisolone plus chlorambucil versus methylprednisolone plus cyclophosphamide in idiopathic membranous nephropathy. Journal of the American Society of Nephrology : JASN, 9(3), 444-450. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/9513907Ponticelli, C., & Glassock, R. J. (2014). Glomerular Diseases: Membranous Nephropathy--A Modern View. Clinical Journal of the American Society of Nephrology, 9(3), 609-616. https://doi.org/10.2215/CJN.04160413R Core Team. (2015). R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing.Ramachandran, R., Hn, H. K., Kumar, V., Nada, R., Yadav, A. K., Goyal, A., … Kohli, H. S. (2016). Tacrolimus combined with corticosteroids versus Modified Ponticelli regimen in treatment of idiopathic membranous nephropathy: Randomized control trial. Nephrology, 21(2), 139-146. https://doi.org/10.1111/nep.12569Ronco, P., & Debiec, H. (2010). Antigen identification in membranous nephropathy moves toward targeted monitoring and new therapy. Journal of the American Society of Nephrology : JASN, 21(4), 564-569. https://doi.org/10.1681/ASN.2009121220Thompson, A., Cattran, D. C., Blank, M., & Nachman, P. H. (2015). Complete and Partial Remission as Surrogate End Points in Membranous Nephropathy. Journal of the American Society of Nephrology, 26(12), 2930-2937. https://doi.org/10.1681/ASN.2015010091Tomas, N. M., Beck, L. H., Meyer-Schwesinger, C., Seitz-Polski, B., Ma, H., Zahner, G., … Lambeau, G. (2014). Thrombospondin Type-1 Domain-Containing 7A in Idiopathic Membranous Nephropathy. New England Journal of Medicine, 371(24), 2277-2287. https://doi.org/10.1056/NEJMoa1409354ORIGINALPDF.pdfPDF.pdfPDFapplication/pdf193436https://bonga.unisimon.edu.co/bitstreams/01d8e021-2e1f-48af-9441-fa6a05a963a1/download10ca1e9e8e1d37ce8b9407335b70206fMD51LICENSElicense.txtlicense.txttext/plain; charset=utf-8368https://bonga.unisimon.edu.co/bitstreams/2c3626f8-ab6f-4bde-9ade-d50bc9480b1e/download3fdc7b41651299350522650338f5754dMD52TEXTEvaluation of Tacrolimus Combined With Corticosteroids vs Modified.pdf.txtEvaluation of Tacrolimus Combined With Corticosteroids vs Modified.pdf.txtExtracted texttext/plain25650https://bonga.unisimon.edu.co/bitstreams/ab3ca0f1-2b06-4e0b-a000-21db01339e89/download613c6159195340ecee3220ddd8842e70MD53PDF.pdf.txtPDF.pdf.txtExtracted texttext/plain25917https://bonga.unisimon.edu.co/bitstreams/1366dd3a-1400-4916-a835-663d378b9190/download195fa3e37a2513c4271b2f30ef0b5629MD55THUMBNAILEvaluation of Tacrolimus Combined With Corticosteroids vs Modified.pdf.jpgEvaluation of Tacrolimus Combined With Corticosteroids vs Modified.pdf.jpgGenerated Thumbnailimage/jpeg1737https://bonga.unisimon.edu.co/bitstreams/688b196f-13cc-49d7-8f02-632454cfcd04/downloadfaf91239c44c03af880447e217d28f80MD54PDF.pdf.jpgPDF.pdf.jpgGenerated Thumbnailimage/jpeg5768https://bonga.unisimon.edu.co/bitstreams/a85c0df1-bf94-41a4-95aa-10f99660c990/download04b41063053ecd6f7bb16e29fcf3a631MD5620.500.12442/2346oai:bonga.unisimon.edu.co:20.500.12442/23462024-07-25 03:05:36.773open.accesshttps://bonga.unisimon.edu.coRepositorio Digital Universidad Simón Bolívarrepositorio.digital@unisimon.edu.coPGEgcmVsPSJsaWNlbnNlIiBocmVmPSJodHRwOi8vY3JlYXRpdmVjb21tb25zLm9yZy9saWNlbnNlcy9ieS1uYy80LjAvIj48aW1nIGFsdD0iTGljZW5jaWEgQ3JlYXRpdmUgQ29tbW9ucyIgc3R5bGU9ImJvcmRlci13aWR0aDowIiBzcmM9Imh0dHBzOi8vaS5jcmVhdGl2ZWNvbW1vbnMub3JnL2wvYnktbmMvNC4wLzg4eDMxLnBuZyIgLz48L2E+PGJyLz5Fc3RhIG9icmEgZXN0w6EgYmFqbyB1bmEgPGEgcmVsPSJsaWNlbnNlIiBocmVmPSJodHRwOi8vY3JlYXRpdmVjb21tb25zLm9yZy9saWNlbnNlcy9ieS1uYy80LjAvIj5MaWNlbmNpYSBDcmVhdGl2ZSBDb21tb25zIEF0cmlidWNpw7NuLU5vQ29tZXJjaWFsIDQuMCBJbnRlcm5hY2lvbmFsPC9hPi4= |