Histologically advanced IgA nephropathy treated successfully with prednisolone and cyclophosphamide.
BACKGROUND
No definitive therapeutic consensus has been established for progressive immunoglobulin A nephropathy (IgAN).


METHODS
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.


RESULTS
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 (<2 mg/dl or > 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.


CONCLUSIONS
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.
Mitsuiki
Koji
K
The Kidney Center, Matsuyama Red Cross Hospital, Bunkyo-cho 1, Matsuyama, 790-8524, Japan. koji@matsuyama.jrc.or.jp.
Harada
Atsumi
A
The Kidney Center, Matsuyama Red Cross Hospital, Bunkyo-cho 1, Matsuyama, 790-8524, Japan.
Okura
Takafumi
T
Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine, Ehime, Japan.
Higaki
Jitsuo
J
Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine, Ehime, Japan.
D000328:Adult; D003404:Creatinine / Q000097:blood; D003520:Cyclophosphamide / Q000008:administration & dosage* / Q000009:adverse effects; D018450:Disease Progression; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005922:Glomerulonephritis, IGA / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D011239:Prednisolone; D003404:Creatinine