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Comparison of immunosuppressive therapies for IgA nephropathy after tonsillectomy: three-course versus one-course steroid pulse combined with mizoribine.

Kaneko T, Arai M, Ikeda M, Morita M, Watanabe Y, Hirama A, Shimizu A, Tsuruoka S - Int Urol Nephrol (2015)

Bottom Line: Treatment effects of steroid on cases already presenting with reduced renal function are unknown.In both the groups, proteinuria decreased significantly 12 months after treatment, and no significant difference in alleviation effects on proteinuria was found between groups. eGFR increased significantly 12 months after treatment in Group A, whereas it tended to decrease in Group B.As for the preservation effect on eGFR, Group A showed significantly higher preservation of eGFR.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology, Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan. tomohiro@nms.ac.jp.

ABSTRACT

Purpose: It has been reported that steroid pulse therapy for IgA nephropathy improves renal prognosis. However, because of the side effects, steroid dose must be restricted to some cases. Treatment effects of steroid on cases already presenting with reduced renal function are unknown. In this study, we performed tonsillectomy in patients with IgA nephropathy and conducted a comparative study about subsequent immunosuppressive therapy.

Methods: Subjects were patients younger than 70 years of age diagnosed with IgA nephropathy by renal biopsy. Treatment protocols were a single-course steroid pulse combined with mizoribine during a period from August 2006 to June 2010 (Group A; n = 34) and a three-course steroid pulse during a period from July 2010 to March 2013 (Group B; n = 32). Primary end points were excretory amounts of proteinuria, disappearance of proteinuria and hematuria, and exacerbation of renal function.

Results: In both the groups, proteinuria decreased significantly 12 months after treatment, and no significant difference in alleviation effects on proteinuria was found between groups. eGFR increased significantly 12 months after treatment in Group A, whereas it tended to decrease in Group B. As for the preservation effect on eGFR, Group A showed significantly higher preservation of eGFR. Similar results were shown in the patients whose eGFR at the start of the treatment was less than 60 mL/min/1.73 m(2).

Conclusions: Single-course steroid pulse therapy combined with mizoribine was considered to have a protective effect on the renal function in IgA nephropathy, especially accompanying renal dysfunction.

No MeSH data available.


Related in: MedlinePlus

Comparison of changes in eGFR at the initiation of the treatment and 12 months later between Group A and Group B. Compared with Group B, a significant increase in eGFR was found in Group A
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Fig5: Comparison of changes in eGFR at the initiation of the treatment and 12 months later between Group A and Group B. Compared with Group B, a significant increase in eGFR was found in Group A

Mentions: Figure 1a, b shows variation in proteinuria at the start of the treatment and 2, 4, 6, 8, 10, and 12 months later. In both groups, significant reduction of proteinuria was found at 12 months later compared with baseline. No significant difference in the alleviation effect on proteinuria was found between groups (Fig. 2). For remission rates after 12 months, no significant difference in proteinuria and urinary occult blood was found between groups. The complete remission rates that both proteinuria and hematuria remitted were 55.8 % in Group A and 53.1 % in Group B, which were not significantly different (Fig. 3). For renal function, Group A showed a significant increase in eGFR at 12 months (71.5 ± 24.6 → 75.1 ± 22.2 mL/min/1.73 m2), whereas Group B tended to show its reduction (77.8 ± 27.0 → 75.3 ± 27.0 mL/min/1.73 m2) (Fig. 4a, b). For the improvement effects on eGFR, the effect in Group A was significantly superior (Fig. 5). In serum creatinine, Group A showed a significant decrease at 12 months (0.93 ± 0.38 → 0.86 ± 0.33 mg/dL), whereas Group B tended to show its increase (0.94 ± 0.37 → 0.96 ± 0.39 mg/dL) (Fig. 6).Fig. 1


Comparison of immunosuppressive therapies for IgA nephropathy after tonsillectomy: three-course versus one-course steroid pulse combined with mizoribine.

Kaneko T, Arai M, Ikeda M, Morita M, Watanabe Y, Hirama A, Shimizu A, Tsuruoka S - Int Urol Nephrol (2015)

Comparison of changes in eGFR at the initiation of the treatment and 12 months later between Group A and Group B. Compared with Group B, a significant increase in eGFR was found in Group A
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4628097&req=5

Fig5: Comparison of changes in eGFR at the initiation of the treatment and 12 months later between Group A and Group B. Compared with Group B, a significant increase in eGFR was found in Group A
Mentions: Figure 1a, b shows variation in proteinuria at the start of the treatment and 2, 4, 6, 8, 10, and 12 months later. In both groups, significant reduction of proteinuria was found at 12 months later compared with baseline. No significant difference in the alleviation effect on proteinuria was found between groups (Fig. 2). For remission rates after 12 months, no significant difference in proteinuria and urinary occult blood was found between groups. The complete remission rates that both proteinuria and hematuria remitted were 55.8 % in Group A and 53.1 % in Group B, which were not significantly different (Fig. 3). For renal function, Group A showed a significant increase in eGFR at 12 months (71.5 ± 24.6 → 75.1 ± 22.2 mL/min/1.73 m2), whereas Group B tended to show its reduction (77.8 ± 27.0 → 75.3 ± 27.0 mL/min/1.73 m2) (Fig. 4a, b). For the improvement effects on eGFR, the effect in Group A was significantly superior (Fig. 5). In serum creatinine, Group A showed a significant decrease at 12 months (0.93 ± 0.38 → 0.86 ± 0.33 mg/dL), whereas Group B tended to show its increase (0.94 ± 0.37 → 0.96 ± 0.39 mg/dL) (Fig. 6).Fig. 1

Bottom Line: Treatment effects of steroid on cases already presenting with reduced renal function are unknown.In both the groups, proteinuria decreased significantly 12 months after treatment, and no significant difference in alleviation effects on proteinuria was found between groups. eGFR increased significantly 12 months after treatment in Group A, whereas it tended to decrease in Group B.As for the preservation effect on eGFR, Group A showed significantly higher preservation of eGFR.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology, Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan. tomohiro@nms.ac.jp.

ABSTRACT

Purpose: It has been reported that steroid pulse therapy for IgA nephropathy improves renal prognosis. However, because of the side effects, steroid dose must be restricted to some cases. Treatment effects of steroid on cases already presenting with reduced renal function are unknown. In this study, we performed tonsillectomy in patients with IgA nephropathy and conducted a comparative study about subsequent immunosuppressive therapy.

Methods: Subjects were patients younger than 70 years of age diagnosed with IgA nephropathy by renal biopsy. Treatment protocols were a single-course steroid pulse combined with mizoribine during a period from August 2006 to June 2010 (Group A; n = 34) and a three-course steroid pulse during a period from July 2010 to March 2013 (Group B; n = 32). Primary end points were excretory amounts of proteinuria, disappearance of proteinuria and hematuria, and exacerbation of renal function.

Results: In both the groups, proteinuria decreased significantly 12 months after treatment, and no significant difference in alleviation effects on proteinuria was found between groups. eGFR increased significantly 12 months after treatment in Group A, whereas it tended to decrease in Group B. As for the preservation effect on eGFR, Group A showed significantly higher preservation of eGFR. Similar results were shown in the patients whose eGFR at the start of the treatment was less than 60 mL/min/1.73 m(2).

Conclusions: Single-course steroid pulse therapy combined with mizoribine was considered to have a protective effect on the renal function in IgA nephropathy, especially accompanying renal dysfunction.

No MeSH data available.


Related in: MedlinePlus