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01-12-2012 | Original Article

Complete remission within 2 years predicts a good prognosis after methylprednisolone pulse therapy in patients with IgA nephropathy

Authors: Miho Tatematsu, Yoshinari Yasuda, Yoshiki Morita, Izumi Sakamoto, Kei Kurata, Tomohiko Naruse, Rhohei Yamamoto, Naotake Tsuboi, Waichi Sato, Enyu Imai, Seiichi Matsuo, Shoichi Maruyama

Published in: Clinical and Experimental Nephrology | Issue 6/2012

Abstract

Background

Pozzi et al. reported the effectiveness of steroid pulse therapy (Pozzi’s regimen) in IgA nephropathy (IgAN). The present study was performed to clarify the predictive factors for IgAN patients treated with Pozzi’s regimen.

Methods

One hundred nine IgAN patients treated by Pozzi’s regimen were observed for up to 112.6 (median 39.7) months, and remission of proteinuria (PR) and disappearance of urinary abnormalities [complete remission (CR)] after Pozzi’s regimen were analyzed. Predictive factors for the glomerular filtration rate (GFR) slopes for up to 5 years were analyzed among 81 patients who were observed for at least 2 years. The outcome of a 50 % increase in sCr was compared between the CR and non-CR groups within 2 years.

Results

Cumulative PR and CR rates increased rapidly until 2 years (54.5 and 46.8 % at 2 years), and then slowly but steadily up to 6 years (72.8 and 66.4 % at 6 years). Baseline characteristics of the CR and non-CR groups within 2 years were similar except for proteinuria. GFR slope was steeper in the non-CR group than in the CR group (−2.44 ± 5.12 vs. −0.32 ± 3.34 ml/min/1.73 m²/year). On multivariate analysis, sex and CR within 2 years were associated with GFR slope. Kaplan-Meier analysis demonstrated a better survival rate in CR group patients without a 50 % increase in sCr (p = 0.024).

Conclusions

Among IgAN patients treated with Pozzi’s regimen, CR within 2 years predicts a good prognosis.

Berger J, Hinglais N. Les depots intercapillaires d’IgA-IgG. J Urol Nephrol (Paris). 1968;74:694–5.

D’Amico G. The commonest glomerulonephritis in the world IgA nephropathy. Q J Med. 1987;245:709–27.

Donadio James V, Grande Joseph P. IgA nephropathy. N Engl J Med. 2002;347:738–48.PubMedCrossRef

Hiki Y, Odani H, Takahashi M, Yasuda Y, Nishimoto A, Iwase H, et al. Mass spectrometry proves under-O-glycosylation of glomerular IgA1 in IgA nephropathy. Kidney Int. 2001;59:1077–85.PubMedCrossRef

Yasuda Y, Horie A, Odani H, Iwase H, Hiki Y. Application of mass spectrometry to IgA nephropathy: structural and biological analyses of underglycosylated IgA1 molecules. Contrib Nephrol. 2004;141:170–88.PubMedCrossRef

Koyama A, Igarashi M, Kobayashi M, Coworkers of the Research Group on Progressive Renal Diseases. Natural history and risk factors for immunoglobulin A nephropathy in Japan. Am J Kidney Dis. 1997;29:526–32.PubMedCrossRef

D’Amico G. Natural history of idiopathic IgA nephropathy and factors predictive of disease outcome. Semin Nephrol. 2004;24:179–96.PubMedCrossRef

Wakai K, Kawamura T, Endoh M, Kojima M, Tomino Y, Tamakoshi A, et al. A scoring system to predict renal outcome in IgA nephropathy: from a nationwide prospective study. Nephrol Dial Transplant. 2006;21:2800–8.PubMedCrossRef

Wakai K, Kawamura T, Matsuo S, Hotta N, Ohno Y. Risk factors for IgA nephropathy: a case-control study in Japan. Am J Kidney Dis. 1999;33:738–45.PubMedCrossRef

10.

Radford MG Jr, Donadio JV Jr, Bergstralh EJ, Grande JP. Predicting renal outcome in IgA nephropathy. J Am Soc Nephrol. 1997;8:199–207.PubMed

11.

Kobayashi Y, Hiki Y, Kokubo T, Horii A, Tateno S. Steroid therapy during the early stage of progressive IgA nephropathy. A 10-year follow-up study. Nephron. 1996;72:237–42.PubMedCrossRef

12.

Pozzi C, Bolasco PG, Fogazzi GB, Andrulli S, Altieri P, Ponticelli C, et al. Corticosteroids in IgA nephropathy: a randomised controlled trial. Lancet. 1999;353:883–7.PubMedCrossRef

13.

Pozzi C, Andrulli S, Del Vecchio L, Melis P, Fogazzi GB, Altieri P, et al. Corticosteroid effectiveness in IgA nephropathy: long-term results of a randomized, controlled trial. J Am Soc Nephrol. 2004;15:157–63.PubMedCrossRef

14.

Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16:31–41.PubMedCrossRef

15.

Locatelli F, Pozzi C, Del Vecchio L, Andrulli S, Bolasco P, Fogazzi G, et al. New therapeutic approaches in primary IgA nephropathy. Adv Nephrol Necker Hosp. 1999;29:73–91.PubMed

16.

Pozzi C, Andrulli S, Pani A, Scaini P, Del Vecchio L, Fogazzi G, et al. Addition of azathioprine to corticosteroids does not benefit patients with IgA nephropathy. J Am Soc Nephrol. 2010;21:1783–90.PubMedCrossRef

17.

Reich HN, Troyanov S, Scholey JW, Cattran DC. Toronto glomerulonephritis registry: remission of proteinuria improves prognosis in IgA nephropathy. J Am Soc Nephrol. 2007;18:3177–83.PubMedCrossRef

18.

Vivante A, Afek A, Frenkel-Nir Y, Tzur D, Farfel A, Golan E, et al. Persistent asymptomatic isolated microscopic hematuria in Israeli adolescents and young adults and risk for end-stage renal disease. JAMA. 2011;17(306):729–36.CrossRef

19.

Szeto CC, Lai FM, To KF, Wong TY, Chow KM, Choi PC, et al. The natural history of immunoglobulin a nephropathy among patients with hematuria and minimal proteinuria. Am J Med. 2001;110:434–7.PubMedCrossRef

20.

Kim BS, Kim YK, Shin YS, Kim YO, Song HC, Kim YS, et al. Natural history and renal pathology in patients with isolated microscopic hematuria. Korean J Intern Med. 2009;24:356–61.PubMedCrossRef

21.

Hotta O, Miyazaki M, Furuta T, Tomioka S, Chiba S, Horigome I, et al. Tonsillectomy and steroid pulse therapy significantly impact on clinical remission in patients with IgA nephropathy. Am J Kidney Dis. 2001;38:736–43.PubMedCrossRef

22.

Komatsu H, Fujimoto S, Hara S, Sato Y, Yamada K, Kitamura K. Effect of tonsillectomy plus steroid pulse therapy on clinical remission of IgA nephropathy: a controlled study. Clin J Am Soc Nephrol. 2008;3:1301–7.PubMedCrossRef

23.

Tomino Y, Sakai H. Special Study Group (IgA Nephropathy) on Progressive glomerular disease. Clinical guidelines for immunoglobulin A (IgA) nephropathy in Japan, second version. Clin Exp Nephrol. 2003;7:93–7.PubMedCrossRef

24.

Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53:982–92.PubMedCrossRef

25.

Fujimi-Hayashida A, Ueda S, Yamagishi S, Kaida Y, Ando R, Nakayama Y, et al. Association of asymmetric dimethylarginine with severity of kidney injury and decline in kidney function in IgA nephropathy. Am J Nephrol. 2011;33:1–6.PubMedCrossRef

26.

Ballardie FW, Roberts IS. Controlled prospective trial of prednisolone and cytotoxics in progressive IgA nephropathy. J Am Soc Nephrol. 2002;13:142–8.PubMed

27.

Ando M, Minami H, Ando Y, Saka H, Sakai S, Yamamoto M, et al. Multi-institutional validation study of carboplatin dosing formula using adjusted serum creatinine level. Clin Cancer Res. 2000;6:4733–8.PubMed

28.

Imai E, Horio M, Yamagata K, Iseki K, Hara S, Ura N, et al. Slower decline of glomerular filtration rate in the Japanese general population: a longitudinal 10-year follow-up study. Hypertens Res. 2008;31:433–41.PubMedCrossRef

29.

Goto M, Wakai K, Kawamura T, Masahiko A, Masayuki E, Yasuhiko T. A scoring system to predict renal outcome in IgA nephropathy: a nationwide 10-year prospective cohort study. Nephrol Dial Transplant. 2009;24:3068–74.PubMedCrossRef

30.

Bjørneklett R, Vikse BE, Bostad L, Iversen BM. Long-term risk of ESRD in IgAN; validation of Japanese prognostic model in a Norwegian cohort. Nephrol Dial Transplant. 2012;27:1485–91

31.

Lv J, Zhang H, Chen Y, Li G, Jiang L, Singh AK, et al. Combination therapy of prednisone and ACE inhibitor versus ACE-inhibitor therapy alone in patients with IgA nephropathy: a randomized controlled trial. Am J Kidney Dis. 2009;53:26–32.PubMedCrossRef

32.

Manno C, Torres DD, Rossini M, Pesce F, Schena FP. Randomized controlled clinical trial of corticosteroids plus ACE-inhibitors with long-term follow-up in proteinuric IgA nephropathy. Nephrol Dial Transplant. 2009;24:3694–701.PubMedCrossRef

33.

Xie Y, Nishi S, Ueno M, Imai N, Sakatsume M, Narita I, et al. The efficacy of tonsillectomy on longterm renal survival in patients with IgA nephropathy. Kidney Int. 2003;63:1861–7.PubMedCrossRef

Title: Complete remission within 2 years predicts a good prognosis after methylprednisolone pulse therapy in patients with IgA nephropathy
Authors: Miho Tatematsu
Yoshinari Yasuda
Yoshiki Morita
Izumi Sakamoto
Kei Kurata
Tomohiko Naruse
Rhohei Yamamoto
Naotake Tsuboi
Waichi Sato
Enyu Imai
Seiichi Matsuo
Shoichi Maruyama
Publication date: 01-12-2012
Publisher: Springer Japan
Published in: Clinical and Experimental Nephrology / Issue 6/2012
Print ISSN: 1342-1751
Electronic ISSN: 1437-7799
DOI: https://doi.org/10.1007/s10157-012-0644-0

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