Long-term Renal Prognosis of IgA Nephropathy with Therapeutic Trend Shifts

被引:18
作者
Asaba, Kensuke [1 ]
Tojo, Akihiro [1 ]
Onozato, Maristela Lika [1 ]
Kinugasa, Satoshi [1 ]
Miyazaki, Hiroki [1 ]
Miyashita, Kazuhisa [1 ]
Uehara, Yoshio [1 ]
Hirata, Yasunobu [1 ]
Kimura, Kenjiro [1 ]
Goto, Atsuo [1 ]
Omata, Masao [1 ]
Fujita, Toshiro [1 ]
机构
[1] Univ Tokyo, Dept Internal Med, Tokyo, Japan
关键词
IgA nephropathy; eGFR; renal survival; renin-angiotensin system; steroid; proteinuria; STEROID PULSE THERAPY; CONTROLLED-TRIAL; DIABETIC NEPHROPATHY; TYPE-2; DIABETES/; PROTEINURIA; TONSILLECTOMY; MULTICENTER; INHIBITION; IRBESARTAN; LOSARTAN;
D O I
10.2169/internalmedicine.48.1938
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective We compared the effect of treatments in the long-term renal survival of IgA nephropathy. Methods One hundred and fourteen patients with biopsy-proven IgA nephropathy were retrospectively divided into 4 groups, reflecting shifts in treatment trends from 1985 to 2005: patients without treatment ( no treatment group; n=36), patients treated only with anti-platelet drugs (anti-platelet group; n=12), those treated mainly with angiotensin-converting enzyme ( ACE) inhibitors or angiotensin receptor blockers (ARBs) (ACEI/ARB group; n =29), and prednisolone-treated patients (PSL group; n =37). Results Baseline blood pressure, serum creatinine and renal histological findings were similar among the 4 groups; however, the urinary protein level was significantly severer in the PSL group. After a mean follow-up of 7.0 +/- 0.5 years, end-stage renal disease occurred in 11 patients (31%) in the no treatment group, 5 patients (42%) in the anti-platelet group and 3 patients (8%) in the PSL group, but in only 1 patient (3%) in the ACEI/ARB group. Kaplan-Meier renal survival after 20 years was significantly better in the ACEI/ARB group than in the anti-platelet group or in the no treatment group (p<0.05). The patients that reached complete remission (CR) by steroid therapy showed less baseline urinary protein and milder histological lesions than those who did not reach CR. The non-CR group showed increases in serum creatinine and eGFR reduction rate. Conclusion Treatment with renin-angiotensin system inhibitors showed the greatest improvement of 20-year renal survival in IgA nephropathy patients. Steroid therapy achieved complete remission in some early-stage cases.
引用
收藏
页码:883 / 890
页数:8
相关论文
共 28 条
[1]  
Berger J., 1968, J UROL NEPHROL, V74, P694
[2]   Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy [J].
Brenner, BM ;
Cooper, ME ;
de Zeeuw, D ;
Keane, WF ;
Mitch, WE ;
Parving, HH ;
Remuzzi, G ;
Snapinn, SM ;
Zhang, ZX ;
Shahinfar, S .
NEW ENGLAND JOURNAL OF MEDICINE, 2001, 345 (12) :861-869
[3]  
CHAUVEAU D, 1993, CONTRIB NEPHROL, V104, P1
[4]   IDIOPATHIC IGA MESANGIAL NEPHROPATHY - CLINICAL AND HISTOLOGICAL STUDY OF 374 PATIENTS [J].
DAMICO, G ;
IMBASCIATI, E ;
DIBELGIOIOSO, GB ;
BERTOLI, S ;
FOGAZZI, G ;
FERRARIO, F ;
FELLIN, G ;
RAGNI, A ;
COLASANTI, G ;
MINETTI, L ;
PONTICELLI, C .
MEDICINE, 1985, 64 (01) :49-60
[5]   Tonsillectomy combined with steroid pulse therapy: A curative therapy for IgA nephropathy [J].
Hotta, O .
ACTA OTO-LARYNGOLOGICA, 2004, 124 :43-48
[6]   Tonsillectomy and steroid pulse therapy significantly impact on clinical remission in patients with IgA nephropathy [J].
Hotta, O ;
Miyazaki, M ;
Furuta, T ;
Tomioka, S ;
Chiba, S ;
Horigome, I ;
Abe, K ;
Taguma, Y .
AMERICAN JOURNAL OF KIDNEY DISEASES, 2001, 38 (04) :736-743
[7]   Chronic Kidney Disease Japan Cohort (CKD-JAC) study: Design and methods [J].
Imai, Enyu ;
Matsuo, Seiichi ;
Makino, Hirofumi ;
Watanabe, Tsuyoshi ;
Akizawa, Tadao ;
Nitta, Kosaku ;
Iimuro, Satoshi ;
Ohashi, Yasuo ;
Hishida, Akira .
HYPERTENSION RESEARCH, 2008, 31 (06) :1101-1107
[8]   IGA NEPHROPATHY - PROGNOSTIC-SIGNIFICANCE OF PROTEINURIA AND HISTOLOGICAL ALTERATIONS [J].
KOBAYASHI, Y ;
TATENO, S ;
HIKI, Y ;
SHIGEMATSU, H .
NEPHRON, 1983, 34 (03) :146-153
[9]   Steroid therapy during the early stage of progressive IgA nephropathy - A 10-year follow-up study [J].
Kobayashi, Y ;
Hiki, Y ;
Kokubo, T ;
Horii, A ;
Tateno, S .
NEPHRON, 1996, 72 (02) :237-242
[10]   Natural history and risk factors for immunoglobulin A nephropathy in Japan [J].
Koyama, A ;
Igarashi, M ;
Kobayashi, M .
AMERICAN JOURNAL OF KIDNEY DISEASES, 1997, 29 (04) :526-532