Methylprednisolone pulse therapy combined with mizoribine following tonsillectomy for immunoglobulin A nephropathy: clinical remission rate, steroid sparing effect, and maintenance of renal function.
BACKGROUND
The long-term prognosis of immunoglobulin A nephropathy (IgAN) is reportedly poor. In Japan, tonsillectomy-steroid pulse therapy has frequently been used for treatment of early IgAN, with favorable outcomes. However, steroid usage is sometimes limited due to adverse reactions. To reduce the total dose of steroids, we have been using mizoribine (MZR) in combination with tonsillectomy-steroid pulse therapy since 2004. Here we report a retrospective evaluation of our protocol outcome.


METHODS
Forty-two patients aged <70 years with histopathologically confirmed IgAN and an estimated glomerular filtration rate (eGFR) of 30 ml/min/1.73 m(2) or higher were enrolled. After giving informed consent, all the patients underwent bilateral tonsillectomy. One week later, intravenous methylprednisolone pulse therapy (500 mg/day) was administered for 3 days, followed by oral prednisolone (30 mg/day and tapered to 0 over 7 months) and MZR (150 mg/day for 11 months). The complete remission (CR) rate and renoprotective effect were assessed.


RESULTS
The CR rate at 6, 12, and 24 months was 33.3, 69.1, and 76.2%, respectively. Despite a relatively low total steroid dose, renal function was satisfactorily maintained for 24 months or longer with no relapse. The eGFR in patients with stage 3 chronic kidney disease was significantly improved at 6 months after start of treatment. Three patients (7.1%) had mild and transient adverse events.


CONCLUSIONS
This protocol appears to be highly effective and safe for IgAN patients with renal dysfunction.
Division of Neurology, Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan. tomohiro@nms.ac.jp
Tomohiro
T
Kaneko
Akio
A
Hirama
Kae
K
Ueda
Teppei
T
Fujino
Koichi
K
Utsumi
Yasuhiko
Y
Iino
Yasuo
Y
Katayama
D000293:Adolescent; D000328:Adult; D005260:Female; D005919:Glomerular Filtration Rate; D005922:Glomerulonephritis, IGA / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007564:Japan; D007668:Kidney / Q000502:physiology*; D007676:Kidney Failure, Chronic / Q000188:drug therapy / Q000503:physiopathology; D007677:Kidney Function Tests; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage* / Q000627:therapeutic use*; D008875:Middle Aged; D020551:Pulse Therapy, Drug; D012074:Remission Induction; D012189:Retrospective Studies; D012263:Ribonucleosides / Q000627:therapeutic use*; D014068:Tonsillectomy; D016896:Treatment Outcome; D055815:Young Adult
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D012263:Ribonucleosides; C010052:mizoribine; D008775:Methylprednisolone