Analysis of the effect of immunosuppressive therapy on the progression of chronic kidney disease with mesangioproliferative nephritis

Aim. To assess the effect of immunosuppressive cyclophosphamide therapy and its regimens on the rate of progression of chronic kidney disease in mesangioproliferative glomerulonephritis.

Methods. 72 patients with mesangioproliferative glomerulonephritis and indications for immunosuppressive therapy with disease activation were included in the comparative analysis: 56 patients received cyclophosphan in conventional doses (26 patients with daily or every other day, 30 patients with in pulse mode 1 time per month), and 16 patients did not receive cyclophosphan. Duration of the disease before observation ranged from 0 to 33.58 years, a median follow-up was 6.00 (interquartile range 1.63–13.17) years, and after observation from 0 to 5 years with the median follow-up was 2.00 (1.00–3.50) years. The examination included nephrobiopsia with a morphological diagnosis, activity index/sclerosis, and glomerulonephritis progression rate for decreased glomerular filtration rate (ml/min/1.73 m² per year).

Results. The progression rate of chronic kidney disease was higher in the group of patients not receiving immunosuppressive therapy, 5.57 (3.27–7.95) ml/min/1.73 m2 per year compared with of the treated patients group, 3.05 (2.04–6.78) ml/min/1.73 m2 per year (p=0.040). There were no differences in the rate of decrease in glomerular filtration rate between groups depending on the treatment regimen: 4.86 (2.12–6.77) ml/min/1.73 m2 per year with regular and 3.67 (2.04– 6.91) ml/min/1.73 m2 per year with a pulse mode (p=0.720). The rate of glomerulonephritis also did not differ significantly: 1.0 (1.0–2.0) and 2.0 (1.0–2.0) relapses over 5 years, respectively (p=0.691) in both treatment regimens.

Conclusion. The treatment of patients with mesangioproliferative glomerulonephritis with cyclophosphane, in combination with prednisone or without it, regardless of the treatment regimen induces a slowdown in the progression of chronic kidney disease, improving the long-term prognosis and without affecting the frequency of relapses of the disease.