Role of proteinuria reduction in the progression of IgA nephropathy.

Autor: Locatelli F; Department of Nephrology and Dialysis, Ospedale A. Manzoni, Lecco, Italy. nefrologia@ospedale.lecco.it, Pozzi C, Del Vecchio L, Bolasco PG, Fogazzi GB, Andrulli S, Melis P, Altieri P, Ponticelli C
Jazyk: angličtina
Zdroj: Renal failure [Ren Fail] 2001 May-Jul; Vol. 23 (3-4), pp. 495-505.
DOI: 10.1081/jdi-100104732
Abstrakt: Unlabelled: Proteinuria has been shown to play a causal role in the progression towards ESRD of IgA nephropathy (IgAN). We demonstrated that steroids are effective in reducing proteinuria and preserving renal function.
Aim: to evaluate the long-term effect of steroids in IgAN patients (6th year evaluation) and better clarify the role of proteinuria reduction in slowing down the progression.
Methods: multicenter randomized controlled trial of 86 adult IgAN patients with serum creatinine < or = 1.5 mg/ dL and moderate proteinuria. They received either supportive therapy or methylprednisolone 1-g i.v. for three days at months 1, 3, and 5, plus oral prednisone (0.5 mg/kg every other day for six months).
Results: Proteinuria significantly decreased in the treated patients (from 2.0+/-0.60 g/24 h at baseline to 1.0+/-0.68 g/24 h at six months) and remained stable till the 6th year (0.67+/-0.5 g/24 h), it slightly decreased in the control group. Six-year renal survival was significantly better in the steroid than in the control group: 9 patient (20.9%) in the steroid group and 15 (34.8%) in the control group reached the primary end-point of a 50% increase in serum creatinine from baseline. Five controls and none of the steroid-treated patients started dialysis. Steroid-treated patients did not experience any major side effects during follow-up.
Conclusions: Steroids significantly reduce proteinuria and protect against renal function deterioration in IgAN patients. Early reduction of proteinuria could also be marker of a persistent reduction in its levels over time and of a better outcome in the long term.
Databáze: MEDLINE
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