Treatment By Csa In Idiopathic Membranous Nephropathy: A Meta-analvsis

Objective:This study aimed to assess the clinical effect and adverse effect, etc. of treatment for idiopathic membranous nephropathy with meta-analysis.Methods:A literature search was performed for studies about treating idiopathic membranous nephropathy with CsA between1985and2011.12.Primary outcome was relative risk(RR) of total, complete or partial remission at the end of follow-up. Secondary outcome included development of end-stage renal function and hypertension and the value of final proteinuria, the final eGFR (estimated glomerular filtration rate) and the final Serum Creatinine level and so on. Standard studies were used by quality evaluation. The outcomes were evaluated by the software "Review manager5" offered by the Cochrane web.Results:Publications in the English and Chinese literature were searched with the keywords’cyclosporine’,’CsA’,’membranous nephropathy’,’membranous glomerulonephritis’,’membranous glomerulonephropathy’,’idiopathic membranous nephropathy’ for clinical trials in electronic databases. Eleven clinical trials of398patients were collected. The publication time was between1995and2011. Among them,9were prospective randomized controlled clinical trials (RCTs),2were non-randomized prospective clinical controlled trials. Meta-analysis showed that compared with the control group, CsA was more effective in total remissions (total RR=1.25,95%CI,1.06-1.48). The final eGFR (estimated glomerular filtration rate) was higher in the CsA group (total SMD=0.60,95%CI,0.14—1.06). The total remission rate is higher in CsA combined with glucocorticoid group compared with CsA alone. The total RR of total remission rate in CsA combined with glucocorticoid group was1.22,(95%CI,1.02-1.44). The total RR of total remission rate in CsA alone group was1.48,(95%CI,0.87-2.52). There was no statistical significance in complete(total RR=1.08,95%CI,0.68-1.71), partial(total RR=1.16,95%CI,0.74-1.83) and total remission rate(total RR=1.12,95%CI,0.89-1.42) when compared with CTX group. The total remission rate is higher when compared with ACEI/ARB(total RRr=1.86,95%CI,1.04-3.32).The complete and partial remission rate, development of end-stage renal function and the value of final proteinuria and the final SCr (Serum Creatinine) level was showed no statistical significance. However, CsA can result in hirsutism(totalRR=4.90,95%CI,1.32-18.19),hypertension(totalRR=2.95,95%CI,1.54-5.63) transient renal function deterioration (total RR=3.38,95%CI,1.23—9.32) and gingival hyperplasia (total RR=5.38,95%CI,1.22—23.7).Adverse effect can be recovered by dosage reduction or drug withdrawl.Conclusion:CsA is more effective than other traditional treatments (with higher remission rate in treating idiopathic membranous nephropathy). The total remission rate is higher in CsA combined with glucocorticoid group compared with CsA alone. There is no statistical significance in complete, partial and total remission rate when compared with CTX group. The total remission rate is higher when compared with ACEI/ARB. CsA has its adverse effect, but it can be recovered by dosage reduction or drug withdrawl.