Long-term follow-up of patients with IgA nephropathy treated with prednisolone and cyclophosphamide therapy.
BACKGROUND
Analyses of selected cases suggest that immunosuppressive treatment could reduce proteinuria and delay the progression of immunoglobulin A nephropathy (IgAN). The aim of this study was to examine the long-term effectiveness of this therapy on the clinical course of IgAN. We also examined the relationship between the efficacy of the treatment and the suppression of the serum immunoglobulin level.


METHODS
Eighteen patients who were observed for more than 2 years after prednisolone and cyclophosphamide therapy were enrolled in this study. Their clinical and laboratory characteristics were recorded for 2-18 years (mean 7.8 +/- 5.7 years).


RESULTS
Of the 18 patients, 13 had remission of proteinuria. We observed the subsequent development of proteinuria in four patients. Fourteen patients had remission of hematuria, with five patients experiencing subsequent relapse of hematuria. The mean time from the treatment to the relapse of proteinuria or hematuria was 5.8 years. Serum immunoglobulins were suppressed by the combination therapy. Serum IgG and IgM recovered 6 months after the treatment, whilst the suppression of serum IgA lasted for 4 years. We found a positive correlation between the serum IgA level and the degree of proteinuria.


CONCLUSIONS
This study indicates that long-term follow-up is essential in order to prove the long-term benefit of immunosuppressive therapy in patients with IgAN. Careful monitoring of the serum IgA level may be useful in the follow-up of patients with IgAN, especially when they are treated with immunosuppressive agents.
Oshima
Satoshi
S
Self Defense Force Central Hospital, 1-2-24 Ikejiri, Setagaya-ku, Tokyo, 154-8566, Japan. nqg02351@nifty.com.|Japan Self Defense Force Beppu Hospital, 3088-24 Beppu, Beppu, Oita, 874-0828, Japan. nqg02351@nifty.com.
Kawamura
Osamu
O
Self Defense Force Central Hospital, 1-2-24 Ikejiri, Setagaya-ku, Tokyo, 154-8566, Japan.|Ishinomaki Loyal Hospital, Miyagi, Japan.
D000328:Adult; D003520:Cyclophosphamide / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005922:Glomerulonephritis, IGA / Q000097:blood / Q000188:drug therapy* / Q000276:immunology; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008297:Male; D011239:Prednisolone / Q000627:therapeutic use*; D016896:Treatment Outcome
D005938:Glucocorticoids; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D011239:Prednisolone