title: The effects of cytotoxic therapy in progressive IgA nephropathy.
abstract: BACKGROUND
  IgA nephropathy (IgAN) is not always benign, and some patients at high risk of end-stage renal disease (ESRD) experience a rapid decline in renal function. This study retrospectively examined the beneficial effects of cytotoxic therapy.
  
  
  METHODS
  We identified 102 patients with progressive IgAN despite optimal conservative management. Of these, 31 who received cytotoxic therapy and 55 who were managed conservatively were included.
  
  
  RESULTS
  Median eGFR and urinary protein-to-creatinine ratio (uPCR) at baseline did not differ between the groups (p = 0.475 and 0.259, respectively). Median GFR slope was also similar (p = 0.896). Cumulative renal survival was better in the cytotoxic therapy group than in the control group (p = 0.009). Cytotoxic therapy was associated with lower risk of progression to ESRD, independent of eGFR, uPCR, GFR slope and kidney histologic findings (HR 0.13, 95% CI 0.03-0.66). In the cytotoxic therapy group, the median GFR slope decreased from -7.8 (-10.5, -5.0) mL/min/1.73 m(2) per year to -3.4 (-5.1, -1.8) mL/min/1.73 m(2) per year after treatment (p < 0.001). Mortality was not observed, but infection requiring hospitalization occurred at similar rates in both groups (p = 0.886).
  
  
  CONCLUSIONS
  Cytotoxic therapy attenuated the rate of GFR decline and was associated with a favorable renal outcome in patients with progressive IgAN.
authors.affiliation: a Division of Nephrology, Department of Medicine, Samsung Medical Center , Sungkyunkwan University School of Medicine , Seoul , Korea ;
authors.forename: Jung-ho
authors.initials: JH
authors.lastname: Shin
authors.affiliation: a Division of Nephrology, Department of Medicine, Samsung Medical Center , Sungkyunkwan University School of Medicine , Seoul , Korea ;
authors.forename: Jung Eun
authors.initials: JE
authors.lastname: Lee
authors.affiliation: a Division of Nephrology, Department of Medicine, Samsung Medical Center , Sungkyunkwan University School of Medicine , Seoul , Korea ;
authors.forename: Ji Hyeon
authors.initials: JH
authors.lastname: Park
authors.affiliation: b Department of Pathology, Samsung Medical Center , Sungkyunkwan University School of Medicine , Seoul , Korea ;
authors.forename: Sharon
authors.initials: S
authors.lastname: Lim
authors.affiliation: a Division of Nephrology, Department of Medicine, Samsung Medical Center , Sungkyunkwan University School of Medicine , Seoul , Korea ;
authors.forename: Hye Ryoun
authors.initials: HR
authors.lastname: Jang
authors.affiliation: b Department of Pathology, Samsung Medical Center , Sungkyunkwan University School of Medicine , Seoul , Korea ;
authors.forename: Ghee Young
authors.initials: GY
authors.lastname: Kwon
authors.affiliation: a Division of Nephrology, Department of Medicine, Samsung Medical Center , Sungkyunkwan University School of Medicine , Seoul , Korea ;
authors.forename: Wooseong
authors.initials: W
authors.lastname: Huh
authors.affiliation: c Biostatistics and Clinical Epidemiology Center, Samsung Medical Center , Sungkyunkwan University School of Medicine , Seoul , Korea.
authors.forename: Sin-Ho
authors.initials: SH
authors.lastname: Jung
authors.affiliation: a Division of Nephrology, Department of Medicine, Samsung Medical Center , Sungkyunkwan University School of Medicine , Seoul , Korea ;
authors.forename: Yoon-Goo
authors.initials: YG
authors.lastname: Kim
authors.affiliation: a Division of Nephrology, Department of Medicine, Samsung Medical Center , Sungkyunkwan University School of Medicine , Seoul , Korea ;
authors.forename: Ha Young
authors.initials: HY
authors.lastname: Oh
authors.affiliation: a Division of Nephrology, Department of Medicine, Samsung Medical Center , Sungkyunkwan University School of Medicine , Seoul , Korea ;
authors.forename: Dae Joong
authors.initials: DJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D001706:Biopsy; D003404:Creatinine / Q000652:urine; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003603:Cytotoxins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000187:drug effects*; D005922:Glomerulonephritis, IGA / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D007668:Kidney / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000188:drug therapy*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000188:drug therapy; D056910:Republic of Korea; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D003603:Cytotoxins; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D003404:Creatinine
keywords: Cytotoxic therapy; IgA nephropathy; end-stage renal disease