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New insight into the management of IgA nephropathy

  • Yonghua Zou
  • Min Yang
  • Xin Du
Letter to the editor
  • 91 Downloads

To the Editor

IgA nephropathy (IgAN) is the most common glomerulonephritis in the world, especially in the Asian population. Jicheng Lv and his colleagues have shed new light on the management of IgAN in this issue of JAMA [1]. In the previous study, the IgAN patients with GFR < 50 mL/min were almost excluded from trials. The range of eGFR was 60–90 mL/min/1.73 m2 with glucocorticoid monotherapy in the STOP-IgAN study [2]. However, the wide range of inclusion criteria of eGFR (20–120 mL/min/1.73 m2) [1] is of great advantage in the design, and results indicated that proteinuria had been improved significantly even during the stage of eGFR 20–50 mL/min/1.73 m2. International research suggests that the lower the eGFR, the greater the risk of adverse events [3], so the possible risk of serious side effects of corticosteroids might be lower if the low limit of eGFR is up to 30 or more than 40 mL/min/1.73 m2. In the TESTING trials, an almost threefold lower risk for kidney failure, opposed...

Notes

Acknowledgements

This work was supported by grants from Chinese Society of Nephrology (14050430580).

Compliance with ethical standards

Conflict of interest

No potential conflict of interest relevant to this letter was reported.

References

  1. 1.
    Lv J, Zhang H, Wong MG, et al; TESTING Study Group. Effect of oral methylprednisolone on clinical outcomes in patients with IgA nephropathy: the TESTING randomized clinical trial. JAMA 2017;318(5): 432–42.CrossRefPubMedPubMedCentralGoogle Scholar
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    Rauen T, Eitner F, Fitzner C, et al. STOP-IgAN investigators. Intensive supportive care plus immunosuppression in IgA nephropathy. N Engl J Med. 2015;373:2225–36.CrossRefPubMedGoogle Scholar
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    Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int. 2013; 3(Suppl):1–150.Google Scholar
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    Yang M, Xu G, Ling L, et al. Performance of the creatinine and cystatin C-based equations for estimation of GFR in Chinese patients with chronic kidney disease. Clin Exp Nephrol. 2017;21(2):236–46.CrossRefPubMedGoogle Scholar
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    Bökenkamp A, Laarman CA, Braam KI, et al. Effect of corticosteroid therapy on low-molecular weight protein markers of kidney function. Clin Chem. 2007;53(12):2219–21.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Nephrology 2018

Authors and Affiliations

  1. 1.Outpatient DepartmentNanjing Medical UniversityNanjingChina
  2. 2.Division of Nephrology, Shanghai Fifth People’s HospitalFudan UniversityShanghaiChina
  3. 3.Department of Nephrology, Nanjing First HospitalNanjing Medical UniversityNanjingChina

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