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English to Portuguese: http://www.bmj.com/content/346/bmj.f248 General field: Medical Detailed field: Medical (general)
Source text - English Immunosuppression is an established but controversial treatment for patients with idiopathic membranous nephropathy. Supporting evidence is patchy, particularly for the minority of patients with worsening renal function. A new trial reports that the combination of chlorambucil and prednisolone does slow the decline more effectively than supportive care alone, but side effects were common and potentially serious.
Recruitment was slow, and the trial relatively small, with just 108 patients randomised over three arms. Patients given six months of chlorambucil and prednisolone did best during three years of follow-up, although 19 of 33 still had further substantial reductions in glomerular filtration rate. Renal function declined by at least 20% in 29 of the 36 patients given ciclosporin and 31 of 37 patients managed with supportive care alone. Ciclosporin looked ineffective, and the authors suggest that renal physicians avoid it.
Both active treatments caused serious side effects. Haematological problems such as neutropenia were particularly common in participants given chlorambucil and prednisolone (28/33); eight developed glucose intolerance, and two developed cancer.
Lancet 2013; doi:10.1016/S0140-6736(12)61566-9
Cite this as: BMJ 2013;346:f248
Translation - Portuguese A imunossupressão é um tratamento já estabelecido, porém controverso, para pacientes com nefropatia membranosa idiopática. As evidências que corroboram o tratamento são irregulares, particularmente para a minoria dos pacientes que apresenta queda na função renal. Um novo ensaio clínico relata que a combinação de clorambucil e prednisolona é mais efetiva para retardar a queda da função do que o cuidado de apoio isolado, porém os efeitos colaterais foram comuns – e potencialmente graves.
O recrutamento foi lento, e o ensaio clínico, relativamente pequeno – apenas 108 pacientes randomizados em três braços. Pacientes que receberam seis meses de clorambucil e prednisolona apresentaram melhores resultados durante seguimento de três anos, apesar de 19 dos 33 ainda apresentarem redução substancial na taxa de filtração glomerular. Houve queda de no mínimo 20% na função renal em 29 dos 36 pacientes que receberam ciclosporina e em 31 dos 37 pacientes manejados apenas com cuidado de apoio. A ciclosporina foi aparentemente ineficaz, e os autores sugerem que nefrologistas evitem a substância.
Ambos os tratamentos ativos causaram efeitos colaterais graves. Problemas hematológicos, como neutropenia, foram particularmente comuns em participantes que receberam clorambucil e prednisolona (28/33); oito desenvolveram intolerância à glicose, e dois desenvolveram câncer.
Lancet 2013; doi:10.1016/S0140-6736(12)61566-9
Para citar este artigo: BMJ 2013;346:f248
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Years of experience: 19. Registered at ProZ.com: Feb 2011.
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