Efficacy of combination therapy for childhood complicated focal IgA nephropathy.

Autor: Aoto Y; Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan. yuuya06@med.kobe-u.ac.jp., Ninchoji T; Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan., Kaito H; Department of Nephrology, Hyogo Prefectural Kobe Children's Hospital, 1-6-7 Minatojima Minami-cho, Chuo-ku, Kobe, 650-0047, Japan., Shima Y; Department of Pediatrics, Wakayama Medical University, 811-1 Kimiidera, Wakayama641-8509, Japan., Fujimura J; Department of Pediatrics, Kakogawa City Hospital, 439 Honmachi, Kakogawa-cho, Kakogawa, 675-8611, Japan., Kamiyoshi N; Department of Pediatrics, Japanese Red Cross Society Himeji Hospital, 1-12-1 Shimoyamateno, Himeji, 670-8540, Japan., Ishimori S; Department of Pediatrics, Takatsuki General Hospital, 1-3-13 Kosobe-cho, Takatsuki, 569-1192, Japan., Nakanishi K; Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa, 903-0125, Japan., Minamikawa S; Department of Emergency and General Practice, Hyogo Prefectural Kobe Children's Hospital, 1-6-7 Minatojima Minami-cho, Chuo-ku, Kobe, 650-0047, Japan., Ishiko S; Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan., Sakakibara N; Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan., Nagano C; Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan., Horinouchi T; Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan., Yamamura T; Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan., Nagai S; Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan., Kondo A; Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan., Inaguma Y; Department of Nephrology, Hyogo Prefectural Kobe Children's Hospital, 1-6-7 Minatojima Minami-cho, Chuo-ku, Kobe, 650-0047, Japan., Tanaka R; Department of Nephrology, Hyogo Prefectural Kobe Children's Hospital, 1-6-7 Minatojima Minami-cho, Chuo-ku, Kobe, 650-0047, Japan., Yoshikawa N; Clinical Research Center, Takatsuki General Hospital, 1-3-13 Kosobe-cho, Takatsuki, 569-1192, Japan., Iijima K; Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan., Nozu K; Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
Jazyk: angličtina
Zdroj: Clinical and experimental nephrology [Clin Exp Nephrol] 2022 Jun; Vol. 26 (6), pp. 561-570. Date of Electronic Publication: 2022 Feb 09.
DOI: 10.1007/s10157-022-02190-4
Abstrakt: Background: Patients with immunoglobulin A nephropathy who present with focal mesangial proliferation (focal IgAN) can have a relatively good prognosis, and renin-angiotensin system inhibitor (RAS-i) is commonly used as the initial treatment. However, there are some complicated focal IgAN cases with resistance to RAS-i treatment or nephrotic-range proteinuria. Thus, combination therapy including corticosteroids is often used. This study aimed to evaluate the efficacy of combination therapy for complicated focal IgAN cases by comparing to diffuse mesangial proliferation (diffuse IgAN).
Methods: We conducted a multicenter retrospective study on 88 children who received 2-year combination therapy. The participants were classified based on pathological severity: focal IgAN (n = 26) and diffuse IgAN (n = 62).
Results: In total, 26 patients with focal IgAN and 52 with diffuse IgAN achieved proteinuria disappearance within 2 years (100 vs. 83.9%, P = 0.03). Moreover, the time to proteinuria disappearance was significantly shorter in the focal IgAN group than in the diffuse IgAN group (2.9 vs. 4.2 months, P < 0.01) and all patients with focal IgAN achieved proteinuria disappearance within 8 months. At the last observation (8.6 vs. 10.4 years, P = 0.13), only patients with diffuse IgAN (n = 12) had greater than stage 2 chronic kidney disease. In terms of irreversible adverse events, one patient exhibited cataracts.
Conclusion: Combination therapy was significantly effective in patients with complicated focal IgAN. Moreover, the long-term prognosis was good, and the duration of combination therapy for complicated focal IgAN can be decreased to reduce adverse events.
(© 2022. The Author(s), under exclusive licence to The Japanese Society of Nephrology.)
Databáze: MEDLINE
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