UKidney's Ask the Experts

  1. Venkat Vellanki
  2. General Nephrology Questions
  3. Sunday, 20 May 2018
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Hi Jordon

I have a 74 yr gentleman idiopathic membranous nephropathy who migrated to my area of practice after 3 months of ponticelli Rx , after 3rd cycle on cyclophosphamide he developed bad pneumonia and made uneventful recovery. Currently he is in full remission, off steroids and cyclo, his age appropriate cancer screen is negative, His latest PLA 2R ab is undetectable.He is on bisphosohnates, ARBs. I should mention he had steroid psychosis during first cycle, now he is back to baseline good health . My question

1) In senior citizen as him with recent pneumonia and h/o steroid psychosis would you push to complete full ponticelli regimen of 6 months despite having achieved full remission and creat of 0.9, PLA2R being negative at 3 months of therapy

2) Abort rest of the course and follow up, any data on this approach which iam leaning to

Warm regards

Venkat
Responses (1)
Accepted Answer Pending Moderation
Hi Venkat,

In an older person who had toxicity and who is now in remission, you could argue for being conservative and leaving on ARB alone. Another option would be add some calcineurin inhibitor (specifically cyclosporine) to maintain remission.

Regards,

Jordan
  1. more than a month ago
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