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Histologically advanced IgA nephropathy treated successfully with prednisolone and cyclophosphamide

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Abstract

Background

No definitive therapeutic consensus has been established for progressive immunoglobulin A nephropathy (IgAN).

Methods

We retrospectively investigated 35 patients with histologically advanced IgAN. The patients were divided into two groups: 27 received prednisolone and cyclophosphamide (PSL+CPA group) and 8 received supportive treatment (control group). The initial doses of PSL and CPA were 30 mg/day and 50 mg/day, respectively. PSL was tapered to 2.5 mg/day over 2 years and CPA was discontinued at 6 months.

Results

In the control group, mean follow-up duration was 22.9 months, renal progression rate was −20.9 × 10<συπ>−3<?συπ> dl/mg per month, and all patients developed endstage renal disease within 5 years. In the PSL+CPA group, mean follow-up duration was 64.3 months, renal progression rate was −1.5 × 10<συπ>−3<?συπ> dl/mg per month, and renal survival at 5 years was 89.8%. Renal prognosis was markedly improved in the PSL+CPA group compared with the control group. The patients in the PSL+CPA group were divided into two subgroups according to baseline serum creatinine (<2 mg/dl or ≥2 mg/dl); renal survival in the two subgroups was similar (84.4% versus 100% at 5 years). Adverse effects of PSL+CPA were minimal and mild.

Conclusions

It is possible that PSL+CPA therapy safely improved the renal prognosis of patients with severe IgAN who would otherwise have required dialysis therapy within 5 years. However, a prospective, multicenter clinical trial is required to prove the effects and safety of this treatment.

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Authors and Affiliations

  1. The Kidney Center, Matsuyama Red Cross Hospital, Bunkyo-cho 1, Matsuyama, 790-8524, Japan

    Koji Mitsuiki & Atsumi Harada

  2. Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine, Ehime, Japan

    Takafumi Okura & Jitsuo Higaki

Authors
  1. Koji Mitsuiki
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  2. Atsumi Harada
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  3. Takafumi Okura
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  4. Jitsuo Higaki
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Correspondence to Koji Mitsuiki.

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Mitsuiki, K., Harada, A., Okura, T. et al. Histologically advanced IgA nephropathy treated successfully with prednisolone and cyclophosphamide. Clin Exp Nephrol 11, 297–303 (2007). https://doi.org/10.1007/s10157-007-0497-0

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  • DOI: https://doi.org/10.1007/s10157-007-0497-0

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