title: A controlled trial of combined therapy for newly diagnosed severe childhood IgA nephropathy. The Japanese Pediatric IgA Nephropathy Treatment Study Group.
abstract: The most appropriate treatment for patients with IgA nephropathy is controversial. Treatment with prednisolone, azathioprine, heparin-warfarin, and dipyridamole early in the course of disease may prevent immunologic renal injury in children with severe IgA nephropathy. To determine whether similar results can be obtained with a combination of just heparin-warfarin and dipyridamole, the effects of such treatment were compared to those of treatment with prednisolone, azathioprine, heparin-warfarin, and dipyridamole in 78 children with newly diagnosed IgA nephropathy showing diffuse mesangial proliferation. The patients were randomly assigned to receive either prednisolone, azathioprine, heparin-warfarin, and dipyridamole for 2 yr (group 1) or heparin-warfarin and dipyridamole for 2 yr (group 2). All of the 40 patients in group 1 and 34 of the 38 patients in group 2 completed the trial. The mean urinary protein excretion fell in group 1 patients (P < 0.0001), but remained unchanged in group 2 patients. The mean serum IgA concentration was reduced in group 1 patients (P = 0.0002), but was unchanged in group 2 patients. BP and creatinine clearance were normal at the end of the trial in all but one group 2 patient, who developed chronic renal insufficiency. The percentage of glomeruli showing sclerosis was unchanged in group 1 patients, but increased in group 2 patients (P = 0.006). The intensity of mesangial IgA deposits decreased in group 1 patients (P = 0.02), but remained unchanged in group 2 patients. In conclusion, the present study shows that treatment of children with severe IgA nephropathy with prednisolone, azathioprine, heparin-warfarin, and dipyridamole for 2 yr early in the course of disease reduces immunologic renal injury and prevents increase of sclerosed glomeruli.
authors.affiliation: Faculty of Health Science, Kobe University School of Medicine, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Yoshikawa
authors.forename: H
authors.initials: H
authors.lastname: Ito
authors.forename: T
authors.initials: T
authors.lastname: Sakai
authors.forename: Y
authors.initials: Y
authors.lastname: Takekoshi
authors.forename: M
authors.initials: M
authors.lastname: Honda
authors.forename: M
authors.initials: M
authors.lastname: Awazu
authors.forename: K
authors.initials: K
authors.lastname: Ito
authors.forename: K
authors.initials: K
authors.lastname: Iitaka
authors.forename: Y
authors.initials: Y
authors.lastname: Koitabashi
authors.forename: K
authors.initials: K
authors.lastname: Yamaoka
authors.forename: K
authors.initials: K
authors.lastname: Nakagawa
authors.forename: H
authors.initials: H
authors.lastname: Nakamura
authors.forename: S
authors.initials: S
authors.lastname: Matsuyama
authors.forename: Y
authors.initials: Y
authors.lastname: Seino
authors.forename: N
authors.initials: N
authors.lastname: Takeda
authors.forename: S
authors.initials: S
authors.lastname: Hattori
authors.forename: M
authors.initials: M
authors.lastname: Ninomiya
mesh_terms: D000293:Adolescent; D001379:Azathioprine / Q000627:therapeutic use; D001806:Blood Urea Nitrogen; D002648:Child; D004176:Dipyridamole / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005920:Glomerular Mesangium / Q000276:immunology* / Q000473:pathology; D005922:Glomerulonephritis, IGA / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D006417:Hematuria / Q000473:pathology; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis* / Q000097:blood; D008856:Microscopy, Fluorescence; D011239:Prednisolone / Q000627:therapeutic use; D011507:Proteinuria / Q000473:pathology; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D007070:Immunoglobulin A; D014859:Warfarin; D004176:Dipyridamole; D006493:Heparin; D011239:Prednisolone; D001379:Azathioprine