Histologically advanced IgA nephropathy treated successfully with prednisolone and cyclophosphamide
- 1 December 2007
- journal article
- Published by Springer Science and Business Media LLC in Clinical and Experimental Nephrology
- Vol. 11 (4), 297-303
- https://doi.org/10.1007/s10157-007-0497-0
Abstract
No definitive therapeutic consensus has been established for progressive immunoglobulin A nephropathy (IgAN). We retrospectively investigated 35 patients with histologically advanced IgAN. The patients were divided into two groups: 27 received prednisolone and cyclophosphamide (PSL+CPA group) and 8 received supportive treatment (control group). The initial doses of PSL and CPA were 30 mg/day and 50 mg/day, respectively. PSL was tapered to 2.5 mg/day over 2 years and CPA was discontinued at 6 months. In the control group, mean follow-up duration was 22.9 months, renal progression rate was -20.9 x 10(-3) dl/mg per month, and all patients developed endstage renal disease within 5 years. In the PSL+CPA group, mean follow-up duration was 64.3 months, renal progression rate was -1.5 x 10(-3) dl/mg per month, and renal survival at 5 years was 89.8%. Renal prognosis was markedly improved in the PSL+CPA group compared with the control group. The patients in the PSL+CPA group were divided into two subgroups according to baseline serum creatinine ( or =2 mg/dl); renal survival in the two subgroups was similar (84.4% versus 100% at 5 years). Adverse effects of PSL+CPA were minimal and mild. It is possible that PSL+CPA therapy safely improved the renal prognosis of patients with severe IgAN who would otherwise have required dialysis therapy within 5 years. However, a prospective, multicenter clinical trial is required to prove the effects and safety of this treatment.Keywords
This publication has 33 references indexed in Scilit:
- The IgA nephropathy treatment dilemmaKidney International, 2006
- Treatment of IgA nephropathyKidney International, 2006
- IgA glomerulonephritis: beyond angiotensin-converting enzyme inhibitorsNature Clinical Practice Nephrology, 2006
- An “evidence-based” survey of therapeutic options for IgA nephropathy: assessment and criticismAmerican Journal of Kidney Diseases, 2003
- Prednisolone and Azathioprine in IgA NephropathyNephron Clinical Practice, 2003
- Natural history and risk factors for immunoglobulin a nephropathy in JapanAmerican Journal of Kidney Diseases, 1997
- Incidence of biopsy-proven primary glomerulonephritis in an Italian ProvinceAmerican Journal of Kidney Diseases, 1996
- IgA nephropathyKidney International, 1995
- IgA NephropathyMedicine, 1994
- Moderately Proteinuric IgA Nephropathy: Prognostic Prediction of Individual Clinical Courses and Steroid Therapy in Progressive CasesNephron, 1989