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...

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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
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License
Licencia de Creative Commons Reconocimiento-NoComercial-CompartirIgual 4.0 Internacional
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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
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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=