***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Although idiopathic membranous nephropathy ( IMN ) is the most common cause of adult-onset nephrotic syndrome , the management of IMN remains controversial . The aim of this prospect i ve study was to compare the efficacy and drug safety of tacrolimus with that of cyclophosphamide ( CTX ; control group ) in IMN patients receiving corticosteroid therapy .  A total of 100 IMN patients with nephrotic syndrome were r and omly assigned to receive a combination of corticosteroid therapy and either CTX or tacrolimus . During a follow-up period of at least 18 months , the remission rate after 2 months in the tacrolimus group was 65.1 % , which was higher than that of the CTX group ( 44.2 % ) ( p = 0.02 ) . The mean time to partial or complete remission was 2.20 months in the tacrolimus group and 3.92 months in the CTX group ( p < 0.001 ) . We also found significantly greater improvements in the serum albumin levels in the tacrolimus group compared with the CTX group at the 2-month ( p = 0.003 ) and 3-month time points ( p = 0.01 ) . The serum creatinine levels remained stable in both groups . Although remission was quicker and more common in the tacrolimus group ( compared with the CTX group ) before 3 months , there was no superiority of tacrolimus after 6 months . Glucose intolerance , urinary tract infections , and pneumonia were the major side effects observed in this study . All of the side effects were mild and controlled , and there were fewer side effects in the tacrolimus group compared with the CTX group , indicating a better treatment tolerance in the tacrolimus group To assess whether chlorambucil or cyclophosphamide may have a better therapeutic index in patients with idiopathic membranous nephropathy , we compared two regimens based on a 6-mo treatment , alternating every other month methylprednisolone with chlorambucil or methylprednisolone with cyclophosphamide .  Patients with biopsy-proven membranous nephropathy and with a nephrotic syndrome were r and omized to be given methylprednisolone ( 1 g intravenously for 3 consecutive days followed by oral methylprednisolone , 0.4 mg/kg per d for 27 d ) alternated every other month either with chlorambucil ( 0.2 mg/kg per d for 30 d ) or cyclophosphamide ( 2.5 mg/kg per d for 30 d ) . The whole treatment lasted 6 mo ; 3 mo with corticosteroids and 3 mo with one cytotoxic drug . Among 87 patients followed for at least 1 yr , 36 of 44 ( 82 % ; 95 % confidence interval [ CI ] , 67.3 to 91.8 % ) assigned to methylprednisolone and chlorambucil entered complete or partial remission of the nephrotic syndrome , versus 40 of 43 ( 93 % ; 95 % CI , 80.9 to 98.5 % ) assigned to methylprednisolone and cyclophosphamide ( P = 0.116 ) . Of patients who attained remission of the nephrotic syndrome , 11 of 36 in the chlorambucil group ( 30.5 % ) and 10 of 40 in the cyclophosphamide group ( 25 % ) had a relapse of the nephrotic syndrome between 6 and 30 mo . The reciprocal of plasma creatinine improved in the cohort groups followed for 1 yr for both treatment groups ( P < 0.01 ) and remained unchanged when compared with basal values in the cohort groups followed for 2 and 3 yr . Six patients in the chlorambucil group and two in the cyclophosphamide group did not complete the treatment because of side effects . Four patients in the chlorambucil group but none in the cyclophosphamide group suffered from herpes zoster . One patient per group developed cancer . It is concluded that in nephrotic patients with idiopathic membranous nephropathy both treatments may be effective in favoring remission and in preserving renal function for at least 3 yr BACKGROUND Evidence regarding the optimal dose of tacrolimus ( TAC ) in treatment of idiopathic membranous nephropathy ( IMN ) remains inconclusive . The objective of this study was to evaluate the efficacy and safety of low-dose TAC combined with prednisone for patients with IMN . METHODS We conducted a r and omized prospect i ve cohort study in IMN patients : 28 patients received oral TAC  ( target whole blood concentration of 2 - 4 ng/mL ) plus prednisone for 12 months , and 28 patients received prednisone combined with intravenous cyclophosphamide ( CYC )  ( 750 mg/m2 body surface ) once every 4 weeks for 24 weeks . RESULTS Of the 56 patients who completed the 12-month treatment , complete remission ( CR ) occurred in 8 ( 28.6 % ) of the CYC group and 18 ( 64.3 % ) of the TAC group ; partial remission ( PR ) occurred in 10 ( 35.7 % ) of the CYC group and 7 ( 25.0 % ) of the TAC group . The probability of remission ( either CR or PR ) was higher in the TAC group than in the CYC group ( p = 0.0439 , by log-rank test ) . Furthermore , a significantly greater improvement in proteinuria and serum albumin levels was observed in the TAC group compared with the CYC group . Patients treated with TAC can often show a rapid increase in their serum albumin levels before any obvious reduction of urinary protein excretion . Side effects were mild and transitory in both groups . CONCLUSION The results demonstrated that the combined therapy of low-dose TAC and prednisone is an effective and safe therapeutic method for Chinese adults with IMN . Low-dose TAC accompanied by prednisone is enough to induce remission in the majority of patients with IMN BACKGROUND We conducted a pilot trial to compare the effectiveness and safety of 2 different treatments in patients with membranous nephropathy and nephrotic syndrome . METHODS To vali date the hypothesis that the 2 treatments were equivalent , patients with biopsy-proven membranous nephropathy and nephrotic syndrome were r and omly assigned to methylprednisolone alternated with a cytotoxic drug every other month for 6 months ( group A ) or to intramuscular synthetic adrenocorticotropic hormone administered twice a week for 1 year ( group B ) . RESULTS The primary outcome measure is cumulative number of remissions as a first event . Fifteen of 16 patients in group A and 14 of 16 patients in group B entered complete or partial remission as a first event . After a median follow-up of 24 months ( interquartile range , 15 to 25 months ) , there were 4 complete remissions and 8 partial remissions in group A versus 8 complete remissions and 6 partial remissions in group B. Median proteinuria decreased from protein of 5.1 g/d ( interquartile range , 4.0 to 7.3 g/d ) to 2.1 g/d ( interquartile range , 0.4 to 3.8 g/d ; P = 0.004 ) in group A and 6.0 g/d ( interquartile range , 4.4 to 8.5 g/d ) to 0.3 g/d ( interquartile range , 0.2 to 1.9 g/d ; P = 0.049 ) in group B. Two patients from each group interrupted treatment because of side effects or inefficacy . CONCLUSION Most nephrotic patients with membranous nephropathy responded to either treatment . Proteinuria was significantly decreased with both methylprednisolone and cytotoxic agents or prolonged administration of synthetic adrenocorticotropic hormone , without significant differences between these 2 therapies Background Appropriate immunosuppressive therapy for patients with idiopathic membranous nephropathy ( MN ) remains controversial . The effect of mycophenolate mofetil ( MMF ) versus cyclosporine ( CsA ) combined with low-dose corticosteroids was evaluated in patients with idiopathic MN in a multi-center r and omized trial ( NCT01282073 ) . Methods A total of 39 biopsy-proven idiopathic MN patients with severe proteinuria were r and omly assigned to receive MMF combined with low-dose corticosteroids ( MMF group ) versus CsA combined with low-dose corticosteroids ( CsA group ) , respectively , and followed up for 48 weeks . Complete or partial remission rate of proteinuria and estimated glomerular filtration rate ( eGFR ) at 48 weeks were compared . Results The level of proteinuria at baseline and at 48 weeks was 8.9 ± 5.9 and 2.1 ± 3.1 g/day , respectively , in the MMF group compared to 8.4 ± 3.5 and 3.2 ± 5.7 g/day , respectively , in the CsA group . In total , 76.1 % of the MMF group and 66.7 % of the CsA group achieved remission at 48 weeks ( 95 % confidence interval , −0.18 to 0.38 ) . There was no difference in eGFR between the two groups . Anti-phospholipase A2 receptor Ab levels at baseline decreased at 48 weeks in the complete or partial remission group ( P = 0.001 ) , but were unchanged in the no-response group . There were no significant differences between the two groups in changes in the Gastrointestinal Symptom Rating Scale and Gastrointestinal Quality of Life Index scores from baseline to 48 weeks . Conclusion In combination with low-dose corticosteroids , the effect of MMF may not be inferior to that of CsA in patients with idiopathic MN , with similar adverse effects including gastrointestinal symptoms . Trial Registration Clinical Trials.gov Identifier : R and omized trials of rituximab in primary membranous nephropathy ( PMN ) have not been conducted . We undertook a multicenter , r and omized , controlled trial at 31 French hospitals ( NCT01508468 ) . Patients with biopsy-proven PMN and nephrotic syndrome after 6 months of nonimmunosuppressive antiproteinuric treatment ( NIAT ) were r and omly assigned to 6-month therapy with NIAT and 375 mg/m2 intravenous rituximab on days 1 and 8 ( n=37 ) or NIAT alone ( n=38 ) . Median times to last follow-up were 17.0 ( interquartile range , 12.5 - 24.0 ) months and 17.0 ( interquartile range , 13.0 - 23.0 ) months in NIAT-rituximab and NIAT groups , respectively . Primary outcome was a combined end point of complete or partial remission of proteinuria at 6 months . At month 6 , 13 ( 35.1 % ; 95 % confidence interval [ 95 % CI ] , 19.7 to 50.5 ) patients in the NIAT-rituximab group and eight ( 21.1 % ; 95 % CI , 8.1 to 34.0 ) patients in the NIAT group achieved remission ( P=0.21 ) . Rates of antiphospholipase A2 receptor antibody ( anti-PLA2R-Ab ) depletion in NIAT-rituximab and NIAT groups were 14 of 25 ( 56 % ) and one of 23 ( 4.3 % ) patients at month 3 ( P<0.001 ) and 13 of 26 ( 50 % ) and three of 25 ( 12 % ) patients at month 6 ( P=0.004 ) , respectively . Eight serious adverse events occurred in each group . During the observational phase , remission rates before change of assigned treatment were 24 of 37 ( 64.9 % ) and 13 of 38 ( 34.2 % ) patients in NIAT-rituximab and NIAT groups , respectively ( P<0.01 ) . Positive effect of rituximab on proteinuria remission occurred after 6 months . These data suggest that PLA2R-Ab levels are early markers of rituximab effect and that addition of rituximab to NIAT does not affect safety Idiopathic membranous nephropathy is a common cause of nephrotic syndrome whose pathogenesis may involve B-cell functions . Rituximab is a monoclonal antibody that binds to the CD20 antigen on B cells thereby deleting them . We conducted an open-label pilot trial of rituximab treatment in 15 severely nephrotic patients with proteinuria refractory to angiotensin-converting enzyme inhibition and /or receptor blockade but with adequately controlled blood pressure .  Rituximab was given 2 weeks apart and , at 6 months , patients who remained proteinuric but had recovered B-cell counts were given a second course of treatment . Proteinuria was significantly decreased by about half at 12 months . Of the 14 patients who completed follow-up , full remission was achieved in two and partial remission in six patients based upon the degree of proteinuria . Side effects were minor ; however , we found no relationship between the response and number of B cells in the blood , CD20 cells in the kidney biopsy , degree of 
    Output:
    
Thechanges of serum creatinine ( Scr ) was not significantly different between eachtreatments of immunosuppressive agents and the control , except for STE whichhas the possibility of increasing Scr ( SMD , 1.00 ( 95 % CI 0.36 to 1.64)).Comparisons among all treatments of immunosuppressive agents showed nostatistical significance in the outcome of relapse .
Infection , gastrointestinal symptoms , and bone marrow suppression were the common adverseevents associated with most of the immunosuppressive therapies .
This study demonstrates that TAC+TW , TAC and CTX are superior to other immunosuppressive agents in terms of TR and 24 hours UTP .
Moreover , they are all at risk of infection , gastrointestinal symptoms , and myelosuppression .
Furthermore , TAC could increase the risk of glucose intolerance or new-onset diabetes mellitus .
Conversely , STE alone , LEF and MZB seem to have little advantage in clinical treatment of IMN .