The combination therapy of steroids, tacrolimus and mycophenolate mofetil in idiopathic membranous nephropathy coexisting with type 2 diabetes mellitus: a retrospective study

Background: Idiopathic membranous nephropathy (IMN), one of the most common causes resulting into nephrotic syndrome in adults, is usually clinically treated with steroids and/or other immunosuppressive agents. However, the treatment on the patients with IMN coexisting with type 2 diabetes mellitus (DM) is still challenging. There are few convincing literatures available on the efficacy and safety of therapeutic regimens in this subgroup of patients to guide clinical practice. Methods: We retrospectively collected and analyzed the data of twenty-three patients who underwent renal biopsies between January 2013 and March 2018 in our institute and were diagnosed with IMN coexisting with type 2 DM. Nine patients received prednisone combining with tacrolimus and mycophenolate mofetil (group 1), while 14 patients received prednisone and intravenous cyclophosphamide (group 2). The primary endpoint was measured by percentage of patients achieved complete remission (CR) or partial remission (PR), the secondary endpoints included changes of urinary protein excretion from baseline and treatment-related adverse events. Results: The remission rates were compared between the group 1 and the group 2 at both 6 months (44.4% versus 50%, P>0.05 ) and 12 months (77.8% versus 64.3%, P>0.05 ). Significant decrease in urinary protein excretion was observed in both groups during treatment, which was significantly greater in group 1 than that in group 2. No significant renal impairment was observed during the follow-up period. Infections and worsening glycemic control were the most common adverse effects of two therapy. Patients treated with prednisone plus cyclophosphamide were more likely to develop worsening diabetes, while infections tended to be more common in patients treated with prednisone combining with tacrolimus and mycophenolate mofetil. Conclusions: The combination therapy of prednisone, tacrolimus and mycophenolate mofetil is one of the effective and safe options for patients with IMN and type 2 DM.