The effect of long-term treatment with calcineurin inhibitors on renal function in patients with membranous lupus nephritis
Objective:To investigate the clinical efficacy of long-term use of calcineurin inhibitors(CNI)in patients with membranous lupus nephritis(MLN)and the effect on serum creatinine.Methodology:Patients with MLN diagnosed by renal biopsy at the National Clinical Research Centre of Kidney Diseases between January 2010 and January 2020 were enrolled in this study.According to the use time of CNI,the patients were divided into three groups:long-term treatment group,short-term treatment group and the non-CNI group.To observe the efficacy of patients in the induction period in the groups using CNI,the baseline clinicopathological characteristics of patients and changes in serum creatinine during the treatment period were compared among the three groups.Results:A total of 456 patients with MLN were followed for more than 6 months.At a mean follow-up of 78 months,a cumulative total of 411(90.1%)patients achieved renal remission,with 297 patients treated with CNI,for a remission rate of 84.2%.Patients in long-term treatment group had a higher percentage of patients with nephrotic syndrome(P＜0.001),urinary protein(P＜0.001),eGFR(P＜0.001),and haemoglobin(P=0.033)and total cholesterol(P=0.001)than those in the other groups,whereas age(P＜0.001),albumin(P＜0.001)and globulin(P＜0.001)were lower.The percentage of glomerulosclerosis(P=0.011)and the chronic index(P=0.016)were high in non-CNI group,and there were no significant differences in other baseline characteristics among the three groups.At the end of follow-up,serum creatinine increased by 30.4%from baseline,and serum creatinine in the three groups increased by 22.0%(67.18 μmol/L vs 55.69 μmol/L)、35.2%(76.02 μmol/L vs 56.58 μmol/L)and 38.9%(92.82 μmol/L vs 66.3 μmol/),respectively,with no significant difference between groups.Conclusion:CNI is the main therapeutic option for MLN,with a high remission rate on induction therapy and little effect on SCr with long-term use.
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