Clinic effect of leflunomide on refractory primary nephrotic syndrome

Objective To investigate the clinical efficacy and safety of leflunomide in refractory primary nephrotic syndrome.Method Sixty-six patients with refractory primary nephrotic syndrome were involved in this study.Thirty-four patients were treated with leflunomide combined with prednisone for six months.The other thirty-two patients were treated with cyclophosphamide combined with prednisone for six months.The efficacy was assessed by subsequent changes in total of 24h urine protein,liver function and kidney function.Results In the group of leflunomide,the total effective rate was 8.5% and the rate of complete clinical remission(CCR) and significant clinical remission(SCR) and partial clinical remission(PCR) was 64.7%,17.6% and 8.8%,respectively.In the group of cyclophosphamide,the total effective rate was 81.2% and the rate of CCR and SCR and PCR was 50%,12.5% and 12.5%,respectively.The total rate of complete clinical remission and significant clinical remission in LEF group was markedly higher than that in CTX group.The effective rate was 93.75% and 92.3% in subgroup of minimal change disease(MCD) and mesangial proliferative glomerulonephritis(MsPGN),which was significantly higher than 60% in the group of membranous nephropathy(MN).Compared with CTX,total of 24h urine protein was low,and the amount of total plasma protein and plasma albumin was high.The concentration of serum TNF and IL-1 could be reduced equally by LEF and CTX treatment.The total rate of side-effect in LEF group(8.8%) was significantly lower than that in CTX group(43.8%).Conclusion Leflunomide is more effective and safe in treatment of refractory primary nephrotic syndrome than cyclophosphamide.