Abstract
IgA nephropathy is not a one-shot disease, but follows a unique repetitive course from disease onset to progression, remission, and relapse. In order to determine appropriate management strategy for IgA nephropathy, target proteinuria needs to be defined. In two cohort studies examining at time-average proteinuria over the whole follow-up, proteinuria associated with decent renal survival was 1.0 g/day and less than 0.5 g/day. This category of proteinuria is referred to as partial remission. By contrast, a view that clinical remission with complete disappearance of both proteinuria and hematuria at final observation is required for better renal survival is widely common in Japan. However, by strict definition, time-average proteinuria during follow-up and urinary abnormalities at the end of observation period are not predictors of subsequent prognosis. Because of this, the more solid finding of the close association between proteinuria after 1–2 years of intervention and subsequent prognosis is explored to seek target proteinuria in management of IgA nephropathy.
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References
KDIGO board members. KDIGO clinical practice guideline-minimal change nephrotic syndrome. Kidney Int Suppl. 2012;2:177–180.
Cattran DC. Idiopathic membranous glomerulonephritis. Kidney Int. 2001;59:1983–94.
Cattran DC. Management of membranous nephropathy: when and what for treatment. J Am Soc Nephrol. 2005;16:1188–94.
Troyanov S, Wall CA, Miller JA, Scholey JW, Cattran DC, Toronto Glomerulonephritis Registry Group. Focal and segmental glomerulosclerosis: definition and relevance of a partial remission. J Am Soc Nephrol. 2005;16:1061–8.
De Nicola L, Provenzano M, Chiodini P, Borrelli S, Garofalo C, Pacilio M, et al. Independent role of underlying kidney disease on renal prognosis of patients with chronic kidney disease under nephrology care. PLoS One. 2015;10:e0127071.
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.
Le W, Liang S, Hu Y, Deng K, Bao H, Zeng C, et al. Long-term renal survival and related risk factors in patients with IgA nephropathy: results from a cohort of 1155 cases in a Chinese adult population. Nephrol Dial Transplant. 2012;27:1479–85.
Kobayashi Y, Fujii K, Hiki Y, Tateno S, Kurokawa A, Kamiyama M. Steroid therapy in IgA nephropathy: a retrospective study in heavy proteinuric cases. Nephron. 1988;48:12–7.
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.
Donadio JV, Bergstralh EJ, Grande JP, Rademcher DM. Proteinuria patterns and their association with subsequent end-stage renal disease in IgA nephropathy. Nephrol Dial Transplant. 2002;17:1197–203.
Hwang HS, Kim BS, Shin YS, Yoon HE, Song JC, Choi BS, et al. Predictors for progression in immunoglobulin A nephropathy with significant proteinuria. Nephrology (Carlton). 2010;15:236–41.
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.
Hirano K, Kawamura T, Tsuboi N, Okonogi H, Miyazaki Y, Ikeda M, et al. The predictive value of attenuated proteinuria at 1 year after steroid therapy for renal survival in patients with IgA nephropathy. Clin Exp Nephrol. 2013;17:555–62.
Hirano K, Kawamura T, Tsuboi N, Okonogi H, Hanaoka K, Ogura M, et al. Clinical and histological parameters associated with the recurrence of proteinuria after steroid therapy in IgA nephropathy patients. J Am Soc Nephrol. 2013;24:817A.
Tatematsu M, Yasuda Y, Morita Y, Sakamoto I, Kurata K, Naruse T, et al. Complete remission within 2 years predicts a good prognosis after methylprednisolone pulse therapy in patients with IgA nephropathy. Clin Exp Nephrol. 2012;16:883–91.
Suzuki Y, Suzuki H, Yasutake J, Tomino Y. Paradigm shift in activity assessment of IgA nephropathy – optimizing the next generation of diagnostic and therapeutic maneuvers via glycan targeting. Expert Opin Biol Ther. 2015;15:583–93.
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Watanabe, K., Hirano, K. (2016). What Is the Goal for Proteinuria in IgA Nephropathy?. In: Tomino, Y. (eds) Pathogenesis and Treatment in IgA Nephropathy. Springer, Tokyo. https://doi.org/10.1007/978-4-431-55588-9_17
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DOI: https://doi.org/10.1007/978-4-431-55588-9_17
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