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İdiyopatik Membranöz Nefropatinin Başlangıç Tedavisinde Steroidler

Steroid Therapy in Initial Treatment of Idiopathic Membranous Nephropathy

Journal Name:

  • Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi

Publication Year:

  • 2009

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Background : The introduction of renin angiotensin system blockers (RASB) might challenge the previous results of immunosuppressive therapies in idiopathic membranous nephropathy (IMN). We investigated the effectiveness of steroids in addition to treatment including RASB. Methods : The data of patients were retrieved retrospectively. The patients who had been administered any other immunosuppressive drug other than steroids were not included. All the patients were on conventional anti-proteinuric treatments, including RASB. Result s: 29 patients were included (19 of them in the steroid group, follow-up period: 15.4±7.2 months). Thirteen (44.8%) of them had complete remission (9 in the steroid group). Twelve (41.4%) were unresponsive (6 in each group). In the steroid group, 13 (68.4%) patients had either complete or partial remission whereas this number was only 4 (40%) in the others (p>0.05). None of the patients died or required renal replacement therapy. Discussion : Our study did not support the idea of extra benefit of steroid treatment in IMN in addition to conventional treatment. Steroid treatment only increased the partial remission ratio in our study that was in concordance with the previous randomized controlled studies performed in the pre-RASB era. Con clu sion : Steroids added to RASB do not provide additional benefit in IMN patients.
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Abstract (Original Language): 
GİRİŞ: Renin anjiyotensin sistem blokajı (RASB) yapan ilaçların kullanımıyla, idiyopatik membranöz nefropati (İMN)’deki immunosupressiflerin sonuçlarında değişiklik olması muhtemeldir. Burada RASB’ye ek verilen steroidlerin etkinliği araştırılmıştır. Metot : Biyopsiyle tanısı konmuş İMN’li hastaların verileri tarandı. Dahil edilme kriterlerinde belirli proteinüri sınırı veya histopatolojik kriter konmadı. İlk immünsupresif olarak glukokortikoid-dışı ilaç alanlar alınmadı. Tüm hastalar standart anti-proteinürik tedaviler (RASB dahil) almaktaydılar. Bulgular : Toplam 29 hasta dahil edildi (19 hasta steroid grubunda, takip süresi 15,4±7,2 ay). Hastaların 13’ü (%44,8) tam remisyona girmişken (9 hasta steroid grubunda), 12 (%41,4)’si tedavilere yanıtsızdı (her iki gruptan altışar hasta). Kısmi veya tam remisyon sayısı steroid grubunda 13 (%68,4), steroid almayanlarda 4 (%40) bulundu (p>0.05). Hasta kaybı veya renal replasman tedavisi gereken hasta olmadı. Tartışma : Çalışmamız, idiyopatik MN başlangıç tedavisinde steroidlerin belirgin olumlu etkileri olduğunu desteklememektedir. Ayrıca steroid tedavisinin, sadece kısmi remisyon oranlarını artırdığı saptanmıştır ki bu sonuçlar, randomize kontrollü iki büyük çalışmayla benzerdir. Ancak bu çalışmalar henüz RASB’nin rutin uygulanmadığı döneme aittir. Sonuç : Steroidler, proteinüri nefrotik düzeyde de olsa, RASB kullanan hastalarda ek fayda sağlamamaktadırlar.
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  • 2
62-68
  • Turkish

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ÖZTÜRK: İdiyopatik Membranöz Nefropatinin Başlangıç
Tedavisinde Steroidler
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