Abstract
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 × 10<συπ>−3<?συπ> 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 × 10<συπ>−3<?συπ> 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 ≥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.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
G D'Amico (1987) ArticleTitleThe commonest glomerulonephritis in the world: IgA nephropathy Q J Med 64 709–27 Occurrence Handle3329736
P Stratta GP Segoloni C Canavese L Sandri G Mazzucco D Roccatello et al. (1996) ArticleTitleIncidence of biopsy-proven primary glomerulonephritis in an Italian province Am J Kidney Dis 27 631–9 Occurrence Handle1:STN:280:DyaK287ps1yntA%3D%3D Occurrence Handle10.1016/S0272-6386(96)90096-7 Occurrence Handle8629621
JH Galla (1995) ArticleTitleIgA nephropathy Kidney Int 47 377–87 Occurrence Handle1:STN:280:DyaK2M3jvF2mtg%3D%3D Occurrence Handle10.1038/ki.1995.50 Occurrence Handle7723227
A Koyama M Igarashi M Kobayashi (1997) ArticleTitleNatural history and risk factors for immunoglobulin A nephropathy in Japan Am J Kidney Dis 29 526–32 Occurrence Handle1:STN:280:DyaK2s3lsVKgsg%3D%3D Occurrence Handle10.1016/S0272-6386(97)90333-4 Occurrence Handle9100040
E Alamartine JC Sabatier C Guerin JM Berliet F Berthoux (1991) ArticleTitlePrognostic factors in mesangial IgA glomerulonephritis: an extensive study with univariate and multivariate analyses Am J Kidney Dis 18 12–9 Occurrence Handle1:STN:280:DyaK3M3ptVShsQ%3D%3D Occurrence Handle10.1016/S0272-6386(12)80284-8 Occurrence Handle2063844
LS Ibels AZ Gyory (1994) ArticleTitleIgA nephropathy: analysis of the natural history, important factors in the progression of renal disease, and a review of the literature Medicine 73 79–102 Occurrence Handle1:STN:280:DyaK2c3gtlSntg%3D%3D Occurrence Handle10.1097/00005792-199403000-00002 Occurrence Handle8152367
GF Strippoli C Manno FP Schena (2003) ArticleTitleAn “evidence-based” survey of therapeutic options for IgA nephropathy: assessment and criticism Am J Kidney Dis 41 1129–39 Occurrence Handle1:CAS:528:DC%2BD3sXkvFOisL8%3D Occurrence Handle10.1016/S0272-6386(03)00344-5 Occurrence Handle12776264
J Floege F Eitner (2005) ArticleTitlePresent and future therapy options in IgA-nephropathy J Nephrol 18 354–61 Occurrence Handle1:CAS:528:DC%2BD28Xisl2ntg%3D%3D Occurrence Handle16245237
F Locatelli L Del Vecchio C Pozzi (2006) ArticleTitleIgA glomerulonephritis: beyond angiotensin-converting enzyme inhibitors Nat Clin Pract Nephrol 2 24–31 Occurrence Handle1:CAS:528:DC%2BD28XhvVSrsr0%3D Occurrence Handle10.1038/ncpneph0055 Occurrence Handle16932386
J Barratt J Feehally (2006) ArticleTitleTreatment of IgA nephropathy Kidney Int 69 1934–8 Occurrence Handle1:CAS:528:DC%2BD28XkvVyrsbg%3D Occurrence Handle10.1038/sj.ki.5000419 Occurrence Handle16641928
GB Appel M Waldman (2006) ArticleTitleThe IgA nephropathy treatment dilemma Kidney Int 69 1939–44 Occurrence Handle1:CAS:528:DC%2BD28XkvVyrsbk%3D Occurrence Handle10.1038/sj.ki.5000434 Occurrence Handle16641925
R Katafuchi K Ikeda T Mizumasa H Tanaka T Ando T Yanase et al. (2003) ArticleTitleControlled, prospective trial of steroid treatment in IgA nephropathy: a limitation of low-dose prednisolone therapy Am J Kidney Dis 41 972–83 Occurrence Handle1:CAS:528:DC%2BD3sXktVOqs7Y%3D Occurrence Handle10.1016/S0272-6386(03)00194-X Occurrence Handle12722031
Y Kobayashi Y Hiki K Fujii A Kurokawa S Tateno (1989) ArticleTitleModerately proteinuric IgA nephropathy: prognostic prediction of individual clinical courses and steroid therapy in progressive cases Nephron 53 250–6 Occurrence Handle1:STN:280:DyaK3c%2FhsFCksw%3D%3D Occurrence Handle10.1159/000185753 Occurrence Handle2797345
O Hotta M Miyazaki T Furuta S Tomioka S Chiba I Horigome et al. (2001) ArticleTitleTonsillectomy and steroid pulse therapy significantly impact on clinical remission in patients with IgA nephropathy Am J Kidney Dis 38 736–43 Occurrence Handle1:STN:280:DC%2BD3MrivF2nsQ%3D%3D Occurrence Handle10.1053/ajkd.2001.27690 Occurrence Handle11576876
S Tamura K Ueki H Ideura Y Tsukada A Maezawa H Kawai et al. (2001) ArticleTitleCorticosteroid therapy in patients with IgA nephropathy and impaired renal function Clin Nephrol 55 192–5 Occurrence Handle1:CAS:528:DC%2BD3MXpt1Khu70%3D Occurrence Handle11316238
M Sato O Hotta S Tomioka I Horigome S Chiba M Miyazaki et al. (2003) ArticleTitleCohort study of advanced IgA nephropathy: efficacy and limitations of corticosteroids with tonsillectomy Nephron Clin Pract 93 c137–45 Occurrence Handle1:CAS:528:DC%2BD3sXktFSmsrg%3D Occurrence Handle10.1159/000070233 Occurrence Handle12759582
C Pozzi S Andrulli L Del Vecchio P Melis GB Fogazzi P Altieri et al. (2004) ArticleTitleCorticosteroid effectiveness in IgA nephropathy: long-term results of a randomized, controlled trial J Am Soc Nephrol 15 157–63 Occurrence Handle1:CAS:528:DC%2BD2cXhs1ahsg%3D%3D Occurrence Handle10.1097/01.ASN.0000103869.08096.4F Occurrence Handle14694168
K Tsuruya A Harada H Hirakata K Mitsuiki T Johko H Kondoh et al. (2000) ArticleTitleCombination therapy using prednisolone and cyclophosphamide slows the progression of moderately advanced IgA nephropathy Clin Nephrol 53 1–9 Occurrence Handle1:CAS:528:DC%2BD3cXjtFWqs7Y%3D Occurrence Handle10661476
CW McIntyre RJ Fluck SH Lambie (2001) ArticleTitleSteroid and cyclophosphamide therapy for IgA nephropathy associated with crescenteric change: an effective treatment Clin Nephrol 56 193–8 Occurrence Handle1:CAS:528:DC%2BD3MXot1Oqsr4%3D Occurrence Handle11597033
FW Ballardie IS Roberts (2002) ArticleTitleControlled prospective trial of prednisolone and cytotoxics in progressive IgA nephropathy J Am Soc Nephrol 13 142–8 Occurrence Handle1:CAS:528:DC%2BD38XltV2gtg%3D%3D Occurrence Handle11752031
JA Tumlin V Lohavichan R Hennigar (2003) ArticleTitleCrescentic, proliferative IgA nephropathy: clinical and histological response to methylprednisolone and intravenous cyclophosphamide Nephrol Dial Transplant 18 1321–9 Occurrence Handle1:CAS:528:DC%2BD3sXks1WqurY%3D Occurrence Handle10.1093/ndt/gfg081 Occurrence Handle12808169
FM Rasche CH Klotz D Czock W Karges R Muche PM Jehle et al. (2003) ArticleTitleCyclophosphamide pulse therapy in advanced progressive IgA nephropathy Nephron Clin Pract 93 c131–6 Occurrence Handle1:CAS:528:DC%2BD3sXktFSmsrs%3D Occurrence Handle10.1159/000070232 Occurrence Handle12759581
N Yoshikawa H Ito T Sakai Y Takekoshi M Honda M Awazu et al. (1999) ArticleTitleA controlled trial of combined therapy for newly diagnosed severe childhood IgA nephropathy. The Japanese Pediatric IgA Nephropathy Treatment Study Group J Am Soc Nephrol 10 101–9 Occurrence Handle1:CAS:528:DyaK1MXmvFSisA%3D%3D Occurrence Handle9890315
DS Goumenos P Davlouros AM El Nahas M Ahuja JR Shortland JG Vlachojannis et al. (2003) ArticleTitlePrednisolone and azathioprine in IgA nephropathy – a 10-year follow-up study Nephron Clin Pract 93 c58–68 Occurrence Handle1:CAS:528:DC%2BD3sXitVSjs74%3D Occurrence Handle10.1159/000068522 Occurrence Handle12616032
X Chen P Chen G Cai J Wu Y Cui Y Zhang et al. (2002) ArticleTitleA randomized control trial of mycophenolate mofetil treatment in severe IgA nephropathy (in Chinese) Zhonghua Yi Xue Za Zhi 82 796–801 Occurrence Handle12126522
BD Maes R Oyen K Claes P Evenepoel D Kuypers J Vanwalleghem et al. (2004) ArticleTitleMycophenolate mofetil in IgA nephropathy: results of a 3-year prospective placebo-controlled randomized study Kidney Int 65 1842–9 Occurrence Handle1:CAS:528:DC%2BD2cXktl2gtLg%3D Occurrence Handle10.1111/j.1523-1755.2004.00588.x Occurrence Handle15086925
S Tang JC Leung LY Chan YH Lui CS Tang CH Kan et al. (2005) ArticleTitleMycophenolate mofetil alleviates persistent proteinuria in IgA nephropathy Kidney Int 68 802–12 Occurrence Handle1:CAS:528:DC%2BD2MXpt1Wmtbc%3D Occurrence Handle10.1111/j.1523-1755.2005.00460.x Occurrence Handle16014059
G Frisch J Lin J Rosenstock G Markowitz V D'Agati J Radhakrishnan et al. (2005) ArticleTitleMycophenolate mofetil (MMF) vs placebo in patients with moderately advanced IgA nephropathy: a double-blind randomized controlled trial Nephrol Dial Transplant 20 2139–45 Occurrence Handle1:CAS:528:DC%2BD2MXhtVWntL7I Occurrence Handle10.1093/ndt/gfh974 Occurrence Handle16030050
U Schöll U Wastl T Risler N Braun B Grabensee P Heering et al. (1999) ArticleTitleThe “point of no return” and the rate of progression in the natural history of IgA nephritis Clin Nephrol 52 285–92 Occurrence Handle10584991
Y Kobayashi K Fujii Y Hiki S Tateno (1986) ArticleTitleSteroid therapy in IgA nephropathy: a prospective pilot study in moderate proteinuric cases Q J Med 61 935–43 Occurrence Handle1:STN:280:DyaL2szhvVCrtQ%3D%3D Occurrence Handle3628707
Y Kobayashi Y Hiki T Kokubo AY Horii S Tateno (1996) ArticleTitleSteroid therapy during the early stage of progressive IgA nephropathy: a 10-year follow-up study Nephron 72 237–42 Occurrence Handle1:CAS:528:DyaK28Xhs1Kqt7o%3D Occurrence Handle10.1159/000188848 Occurrence Handle8684533
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Mitsuiki, K., Harada, A., Okura, T. et al. Histologically advanced IgA nephropathy treated successfully with prednisolone and cyclophosphamide. Clin Exp Nephrol 11, 297–303 (2007). https://doi.org/10.1007/s10157-007-0497-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10157-007-0497-0