Renal function, protein concentrations, and plasma and urinary TNF- in patients treated with pentoxifylline 25-hydroxyvitamin D-1-hydroxylase in normal and malignant colon tissue

production of TNF-α . 3 We postulated that pentoxifylline (1200 mg/day) could reduce proteinuria in patients with MGN. We did a single-centre, prospective, pilot study to assess the effects of pentoxifylline on proteinuria in patients with idiopathic MGN. The study was done between April, 1999 and August, 2000. Ten patients were included in the study. The inclusion criteria were the following: histologically proven idiopathic MGN; persistent nephrotic syndrome despite treatment with angiotensin converting enzyme inhibitors at full doses; neither steroids nor immunosuppressive treatment. Exclusion criteria were secondary MGN or hypersensitivity to pentoxifylline. Serum creatinine concentration, total serum protein, serum albumin, and urinary protein excretion (UPE) were measured 3 months and 1 month before pentoxifylline treatment, at the start of pentoxifylline treatment, and at 3 and 6 months after starting treatment. TNF-α was measured at the start of pentoxifylline treatment and 6 months later. Data at the start of treatment and at 6 months of treatment were compared using the paired Wilcoxon test. Ten patients (four men, six women) were included and followed up for 6 months. Two patients had grade 1 MGN, four grade 2 MGN, and four grade 3 MGN. Mean duration of disease was 22 (range 7–46) months. At 6 months after the start of pentoxifylline, nine patients (90%) were in remission of nephrotic syndrome. Bilateral renal vein thrombosis was diagnosed 2 months after the start of the study in the patient with persistent nephrotic syndrome. Mean UPE decreased from 11 (4·6–27) to 1·8 (0–10·9) g/day (p=0·001), whereas serum albumin concentration increased from 17 g/L (14–25) to 39 (27–46) (p=0·0004). In five patients (50%), UPE was less than 0·3 g/day at 6 months. Renal function remained stable during the study (table). Both urinary and plasma TNF-α significantly decreased during the study period (table). Pentoxifylline may reduce TNF-α at 6 months in patients with MGN. Prospective randomized studies are needed to investigate the possibility that pentoxifylline may be an adjunct or an alternative to steroids and immunosuppressants in patients with MGN.