Evaluation of appropriate treatment for IgA nephropathy with mild proteinuria and normal renal function
| Autor: | Shota Ogura, Kosaku Nitta, Kazunori Karasawa, Yoei Miyabe, Takahito Moriyama |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male Nephrology medicine.medical_specialty Time Factors Physiology Prednisolone Urinary system Anti-Inflammatory Agents Mild proteinuria Renal function Conservative Treatment urologic and male genital diseases Gastroenterology Nephropathy Young Adult Physiology (medical) Internal medicine Recoverin Humans Medicine Adverse effect Hematuria Retrospective Studies Tonsillectomy Proteinuria business.industry Remission Induction Glomerulonephritis IGA Retrospective cohort study Prognosis medicine.disease Disease Progression Female medicine.symptom business Glomerular Filtration Rate |
| Zdroj: | Clinical and Experimental Nephrology. 25:1103-1110 |
| ISSN: | 1437-7799 1342-1751 |
| DOI: | 10.1007/s10157-021-02086-9 |
| Popis: | Tonsillectomy and steroid pulse therapy (TSP) for immunoglobulin A nephropathy (IgAN) is frequently employed in many Japanese institutions; however, performing this invasive treatment in patients with mild IgAN is controversial. This study aimed to evaluate the appropriate treatment for IgAN patients with mild proteinuria. In this retrospective cohort analysis, 122 IgAN patients with mild proteinuria (0.5–1.0 g/day) and estimated glomerular filtration rate of ≥ 60 mL/min/1.73 m2 were classified into three groups as follows: patients treated with TSP (n = 32), oral prednisolone (oPSL, n = 33), and conservative therapy (CONS, n = 47). The clinical and histological backgrounds, 5-year remission rates of urinary findings, and 10-year renal survival rates were analyzed. The backgrounds were similar among the three groups. The remission rates of hematuria, proteinuria, and both were significantly higher for TSP and oPSL than for CONS; however, they were similar for TSP and oPSL. In the multivariate Cox regression analysis, TSP and oPSL were independent factors for the remission of urinary findings compared with CONS; however, the relapse rates of urinary abnormalities were similar among the three groups. No patient progressed to end-stage renal disease (ESRD) within 10 years. Adverse effects of corticosteroid therapy were significantly more frequent in oPSL than in TSP. In IgAN patients with mild proteinuria and stable renal function, similar to oPSL, TSP showed higher remission rates of hematuria and/or proteinuria than CONS, and no case progressed to ESRD regardless of the treatment methods. Therefore, appropriate treatments should be carefully considered for each patient. |
| Databáze: | OpenAIRE |
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