Prognostic Model of GC/CTX in the Treatment of MN

Study Overview
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Brief Summary
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The goal of this observational study is to explore the factors that can predict the prognosis difference in patients with idiopathic membranous nephropathy (IMN) under the treatment of glucocorticoid + cytoxan. The main questions it aims to answer are: to explore the factors that can predict the prognosis difference in patients with IMN under the treatment of glucocorticoid + cytoxan to establish a clinical prediction model and verify it to provide a reference for the early Participants will receive standard glucocorticoid + cytoxan treatment and will then be divided into remission and non remission groups based on the treatment effect after the standard treatment cycle. Blood, urine, and fecal samples were collected from patients to explore possible factors influencing treatment efficacy. Researchers will compare [remission group and non-remission group] to see if the gut microbiota and its metabolites are factors that influence the efficacy of treatment.

Official Title
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Development and Validation of a Prognostic Model for Idiopathic Membranous Nephropathy Treated With Glucocorticoids Plus Cytoxan

Conditions
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Idiopathic Membranous Nephropathy

Intervention / Treatment
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* Drug: glucocorticoid + cytoxan


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Aged 18-75 years, the patient was diagnosed as idiopathic membranous nephropathy or anti phospholipase A2 receptor (PLA2R) antibody positive by renal puncture biopsy, and the clinical data were complete; According to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines in 2020, it conforms to the medium and high risks in the risk level of progression of renal function loss. In general, they are in good condition, have a good understanding of their own conditions and physical conditions, have self-awareness, and can communicate well with others; Volunteer to participate in the study, understand the significance of this experiment and the indicators to be measured, and sign the informed consent form. Exclusion Criteria: There are factors causing secondary membranous nephropathy, such as immune diseases (systemic lupus erythematosus), tumors/infections (viral hepatitis), drugs or toxins; At the same time, immunoglobulin A nephropathy (IgAN), interstitial nephritis, acute nephritis and other renal pathological types were combined; The medication was not standardized during the treatment process, accompanied by serious infection, acute renal injury and other complications, and serious cardiovascular, cerebrovascular, digestive and blood system diseases; During follow-up, the patient cannot actively cooperate or accurately understand and express.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Remission<br> | Drug: glucocorticoid + cytoxan<br>* The initial full dose of prednisone was 1mg/kg/d (the maximum dose was 60mg/d) for 6-8 weeks, and then slowly decreased by 10% of the original dose every 1-2 weeks, and the later small dose was maintained at 0.4-0.5mg/kg/d; Cyclophosphamide 200mg/time, intravenous drip or oral every other day, up to the cumulative dose of 6-8g.<br>|
| Non-remission<br> | Drug: glucocorticoid + cytoxan<br>* The initial full dose of prednisone was 1mg/kg/d (the maximum dose was 60mg/d) for 6-8 weeks, and then slowly decreased by 10% of the original dose every 1-2 weeks, and the later small dose was maintained at 0.4-0.5mg/kg/d; Cyclophosphamide 200mg/time, intravenous drip or oral every other day, up to the cumulative dose of 6-8g.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Remission | None-Remission of the State of MN: 1) 24-hour urin protein (24-h UP)>3.5 g, or 24-h UP<50% lower than the baseline, or serum creatinine increased by 50% compared with the baseline; 2) Renal function progress: Compared with the initial examination, estimated glomerular filtration rate (eGFR) progress is greater than or equal to 30%; 3) End stage renal disease: eGFR<15ml/min, or renal replacement therapy. Partial Remission of the State of MN: 24-h UP is 0.5-3.5 g, and 24-h UP is more than 50% lower than the baseline, serum creatinine is normal, and plasma albumin is ≥ 30 g. Complete Remission of the State of MN: 24-h UP<0.5g, serum creatinine normal, plasma albumin ≥ 35g. | 6 months |