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    《2006CARI指南—膜性腎病：環(huán)孢素治療的作用》內(nèi)容簡(jiǎn)介：

    Idiopathic MGN is the most common form of nephrotic syndrome in **s. Althoughmany patients have a benign course or undergo spontaneous complete or partialremission, 30–40% of patients progress toward nd-stage kidney disease （ESKD）within 5–15 years （Schieppati et al 1993; Geddes et al 2000）， sometimes months oryears after the onset of nephrotic syndrome and a substantial percentage of patientsnever progress to kidney failure. To avoid possibly unnecessary treatments, mostclinical studies have focused on individuals who are thought to be at greater risk forprogressive disease. The objective of this guideline is to evaluate the availableclinical evidence pertaining to the impact of cyclosporine on renal functional declinein MGN with poor prognostic features, such as heavy proteinuria （> 3 g/24 h），impaired renal function at presentation, deteriorating renal function and/orreducedresponse to therapy.

    《2006CARI指南—膜性腎?。涵h(huán)孢素治療的作用》內(nèi)容預(yù)覽：

    Cattran et al （1995） randomised 51 patients with biopsy-proven idiopathicMGN and nephrotic-range proteinuria to 26 weeks of cyclosporine treatmentplus low-dose prednisone to placebo plus prednisone. Seventy five per cent ofthe treatment group vs. 22% of the control group （P < 0.001） had a partial orcomplete remission of their proteinuria by 26 weeks. Relapse occurred in 43%（N = 9） of the cyclosporine remission group and 40% （n = 2） of the placebogroup by week 52. Form this time until the end of the study at 78 weeks, thefraction of the total population in remission remained unchanged （cyclosporine39%, placebo 13%, P = 0.007）。 Renal insufficiency, defined as doubling ofbaseline creatinine, was seen in 2 patients in each group.

    In a recent meta-**ysis of placebo-controlled trials of cyclosporine/prednisolone,involving 104 randomised patients, no clinically relevant beneficial effect wasobserved （Schieppati et al 2004）。 Nonetheless, partial remissions were morefrequent in cyclosporine-treated patients than in those treated with alkylating agents（partial remission RR 1.68, 95%CI: 1.06–2.65, P = 0.03）.

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