The improvement of renal survival with steroid pulse therapy in IgA nephropathy

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Abstract

Background. The benefits of steroid therapy in immunoglobulin A nephropathy (IgAN) have not been established.

Methods. The effect of steroids on kidney survival was retrospectively investigated in 702 patients with IgAN by multivariate analyses.

Results. There were 295 men and 407 women. The median follow-up period was 62 months. One hundred and ninety-four patients were treated with oral steroids (oral steroid group). Thirty-four patients were treated with methylprednisolone (mPSL) pulse therapy (pulse steroid group) followed by oral prednisolone (PSL). In 474 patients, no steroid was used (no steroid group). The urinary protein-creatinine ratio and histological grade were significantly different among treatment groups and were highest in the pulse steroid group followed by the oral steroid group and lowest in the no steroid patients. Serum creatinine was significantly higher in the pulse steroid group than in other two groups. Eighty-five patients developed end-stage renal failure (ESRF) requiring haemodialysis. In multivariate analysis, steroid pulse therapy significantly decreased the risk of ESRF while oral steroid treatment did not improve renal survival in this cohort.

Conclusion. We found that pulse steroid therapy improved kidney survivals in IgAN. Since the clinical findings and histological grade were the most severe in patients treated with mPSL pulse therapy, such therapy may prevent progression of IgAN.

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Most cited references 27

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Corticosteroid effectiveness in IgA nephropathy: long-term results of a randomized, controlled trial.

Simeone Andrulli, C Pozzi, G B Fogazzi … (2003)

Proteinuria plays a causal role in the progression of IgA nephropathy (IgAN). A previous controlled trial showed that steroids are effective in reducing proteinuria and preserving renal function in patients with IgAN. The objective of this study was to evaluate the long-term effectiveness of steroids in IgAN, examine the trend of proteinuria during follow-up (starting from the hypothesis that the degree of reduction in proteinuria may influence IgAN outcome), and evaluate how histologic scores can influence steroid response. A secondary analysis of a multicenter, randomized, controlled trial of 86 adult IgAN patients who were receiving supportive therapy or intravenous methylprednisolone plus oral prednisone for 6 mo was conducted. Ten-year renal survival was significantly better in the steroid than in the control group (97% versus 53%; log rank test P = 0.0003). In the 72 patients who did not reach the end point (doubling in baseline serum creatinine), median proteinuria significantly decreased (1.9 g/24 h at baseline, 1.1 g/24 h after 6 mo, and 0.6 g/24 h after a median of 7 yr). In the 14 progressive patients, proteinuria increased from a median of 1.7 g/24 h at baseline to 2.0 g/24 h after 6 mo and 3.3 g/24 h after a median of 5 yr. Steroids were effective in every histologic class. Cox multivariate regression analyses showed that, in addition to steroids, a low baseline histologic score, a reduction in proteinuria after 6 mo, and no increase in proteinuria during follow-up all were independent predictors of a beneficial outcome. Steroids significantly reduce proteinuria and protect against renal function deterioration in IgAN. The histologic picture and proteinuria during early and late follow-up improve the prediction of outcome, but considerable variability remains outside the model.

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Predicting initiation and progression of chronic kidney disease: Developing renal risk scores.

Michael B Brenner, Maarten Taal (2006)

Epidemiological studies have raised awareness of the problem of undiagnosed chronic kidney disease (CKD) and suggest that early identification and treatment will reduce the global burden of patients requiring dialysis. This has highlighted the twin problems of how to identify subjects for screening and target intervention to those with CKD most likely to progress to end-stage renal disease. Prospective studies have identified risk factors for CKD in the general population as well as risk factors for progression in patients with established CKD. Risk factors may thus be divided into initiating factors and perpetuating factors, with some overlap between the groups. In this paper, we review current data regarding CKD risk factors and illustrate how each may impact upon the mechanisms underlying CKD progression to accelerate loss of renal function. We propose that these risk factors should be used as a basis for developing a renal risk score, analogous to the Framingham risk score for ischemic heart disease, which will allow accurate determination of renal risk in the general population and among CKD patients.

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Tonsillectomy and steroid pulse therapy significantly impact on clinical remission in patients with IgA nephropathy.

Glenn Furuta, Kiyomi Abe, Y Taguma … (2001)

We conducted a retrospective investigation of renal outcome in 329 patients with immunoglobulin A (IgA) nephropathy with an observation period longer than 36 months (82.3 +/- 38.2 months) in our renal unit between 1977 and 1995. Clinical remission, renal progression, and the impact of covariates were estimated by Kaplan-Meier analysis and a Cox regression model. In 157 of 329 patients (48%), disappearance of urinary abnormalities (clinical remission) was obtained. None of these 157 patients showed progressive deterioration, defined as a 50% increase in serum creatinine (Scr) level from baseline, during the observation period. Conversely, in patients without clinical remission, the Kaplan-Meier estimate of probability of progressive deterioration was 21% +/- 5% at 10 years. In the multivariate Cox regression model with 13 independent covariates, initial Scr level, histological score, tonsillectomy, and high-dose methylprednisolone therapy had a significant impact on clinical remission, whereas proteinuria, age, sex, levels of hematuria, blood pressure, conventional steroid therapy, angiotensin-converting enzyme inhibitor therapy, and cyclophosphamide therapy had no significant effect. These findings indicate that interventions aimed at achieving clinical remission have provided encouraging results applicable to managing patients with IgA nephropathy.

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Author and article information

Journal

Journal ID (nlm-ta): Nephrol Dial Transplant

Journal ID (publisher-id): ndt

Journal ID (hwp): ndt

Title: Nephrology Dialysis Transplantation

Publisher: Oxford University Press

ISSN (Print): 0931-0509

ISSN (Electronic): 1460-2385

Publication date (Print): December 2008

Publication date (Electronic): 20 July 2008

Publication date PMC-release: 20 July 2008

Volume: 23

Issue: 12

Pages: 3915-3920

Affiliations

[1 ]The Kidney Unit, Fukuoka Red Cross Hospital

[2 ]The Department of Medicine and Clinical Science, Graduate School of Medical Science, Kyushu University , Fukuoka, Japan

Author notes

Correspondence and offprint requests to: Ritsuko Katafuchi, National Fukuoka-Higashi Medical Center, 1-1-1, Chidori, Koga city, Fukuoka, 811-3195, Japan. Tel: +81-92-943-2331; Fax: +81-92-943-8775; E-mail: katafuchir@ 123456fukuokae2.hosp.go.jp

Article

Publisher ID: gfn394

DOI: 10.1093/ndt/gfn394

PMC ID: 2639065

PubMed ID: 18644797

SO-VID: d62e8782-3f05-480e-9475-a8b4601e3ebe

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The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

The improvement of renal survival with steroid pulse therapy in IgA nephropathy

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Karger: Nephrology

Most cited references 27

Corticosteroid effectiveness in IgA nephropathy: long-term results of a randomized, controlled trial.

Predicting initiation and progression of chronic kidney disease: Developing renal risk scores.

Tonsillectomy and steroid pulse therapy significantly impact on clinical remission in patients with IgA nephropathy.

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