title: Corticosteroid Treatment Influences TA-Proteinuria and Renal Survival in IgA Nephropathy.
abstract: The clinical course of IgA nephropathy (IgAN) and its outcome are extremely variable. Proteinuria at baseline has been considered one of the most important risk factors. More recently, mean proteinuria of follow-up (time-average proteinuria: TAp) was described as a stronger marker of renal survival, suggesting to consider it as a marker of disease activity and response to treatment. We evaluated predictors of renal survival in IgAN patients with different degrees of renal dysfunction and histological lesions, focusing on the role of the therapy in influencing TAp. We performed a retrospective analysis of three prospective, randomized, clinical trials enrolling 325 IgAN patients from 1989 to 2005. Patients were divided into 5 categories according to TAp. The primary endpoint of the 100% increase of serum creatinine occurred in 54 patients (16.6%) and renal survival was much better in groups having lower TAp. The median follow up was 66.6 months (range 12 to 144). The primary endpoint of the 100% increase of serum creatinine occurred in 54 patients (16,6%) and renal survival was much better in groups having lower TA proteinuria. At univariate analysis plasma creatinine and 24h proteinuria, systolic (SBP) and diastolic (DBP) blood pressure during follow-up and treatment with either steroid (CS) or steroid plus azathioprine (CS+A) were the main factors associated with lower TAp and renal survival. At multivariate analysis, female gender, treatment with S or S+A, lower baseline proteinuria and SBP during follow-up remained as the only variables independently influencing TAp. In conclusion, TA-proteinuria is confirmed as one of the best outcome indicators, also in patients with a severe renal insufficiency. A 6-month course of corticosteroids seems the most effective therapy to reduce TAp.
authors.affiliation: Department of Nephrology and Dialysis, E. Bassini Hospital, Cinisello Balsamo, Milan, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Sarcina
authors.affiliation: Biometry and Clinical Epidemiology Unit, Policlinico San Matteo, Pavia, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Tinelli
authors.affiliation: Department of Nephrology and Dialysis, E. Bassini Hospital, Cinisello Balsamo, Milan, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Ferrario
authors.affiliation: Department of Nephrology and Dialysis, E. Bassini Hospital, Cinisello Balsamo, Milan, Italy.
authors.forename: Bianca
authors.initials: B
authors.lastname: Visciano
authors.affiliation: Department of Nephrology and Dialysis, G. Brotzu Hospital, Cagliari, Italy.
authors.forename: Antonello
authors.initials: A
authors.lastname: Pani
authors.affiliation: Biometry and Clinical Epidemiology Unit, Policlinico San Matteo, Pavia, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: De Silvestri
authors.affiliation: Department of Nephrology and Dialysis, E. Bassini Hospital, Cinisello Balsamo, Milan, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: De Simone
authors.affiliation: Department of Nephrology, Dialysis and Renal Transplant A. Manzoni Hospital, Lecco, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Del Vecchio
authors.affiliation: Department of Nephrology and Dialysis, E. Bassini Hospital, Cinisello Balsamo, Milan, Italy.
authors.forename: Veronica
authors.initials: V
authors.lastname: Terraneo
authors.affiliation: Department of Nephrology and Dialysis, E. Bassini Hospital, Cinisello Balsamo, Milan, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Furiani
authors.affiliation: Department of Nephrology and Dialysis, E. Bassini Hospital, Cinisello Balsamo, Milan, Italy.
authors.forename: Gaia
authors.initials: G
authors.lastname: Santagostino
authors.affiliation: Department of Nephrology and Dialysis, E. Bassini Hospital, Cinisello Balsamo, Milan, Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Corghi
authors.affiliation: Department of Nephrology and Dialysis, E. Bassini Hospital, Cinisello Balsamo, Milan, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Pozzi
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000494:pharmacology / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D001379:Azathioprine / Q000494:pharmacology / Q000627:therapeutic use; D003404:Creatinine / Q000097:blood; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005922:Glomerulonephritis, IGA / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000473:pathology; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D003404:Creatinine; D001379:Azathioprine