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Complete remission within 2 years predicts a good prognosis after methylprednisolone pulse therapy in patients with IgA nephropathy

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Abstract

Background

Pozzi et al. reported the effectiveness of steroid pulse therapy (Pozzi’s regimen) in IgA nephropathy (IgAN). The present study was performed to clarify the predictive factors for IgAN patients treated with Pozzi’s regimen.

Methods

One hundred nine IgAN patients treated by Pozzi’s regimen were observed for up to 112.6 (median 39.7) months, and remission of proteinuria (PR) and disappearance of urinary abnormalities [complete remission (CR)] after Pozzi’s regimen were analyzed. Predictive factors for the glomerular filtration rate (GFR) slopes for up to 5 years were analyzed among 81 patients who were observed for at least 2 years. The outcome of a 50 % increase in sCr was compared between the CR and non-CR groups within 2 years.

Results

Cumulative PR and CR rates increased rapidly until 2 years (54.5 and 46.8 % at 2 years), and then slowly but steadily up to 6 years (72.8 and 66.4 % at 6 years). Baseline characteristics of the CR and non-CR groups within 2 years were similar except for proteinuria. GFR slope was steeper in the non-CR group than in the CR group (−2.44 ± 5.12 vs. −0.32 ± 3.34 ml/min/1.73 m2/year). On multivariate analysis, sex and CR within 2 years were associated with GFR slope. Kaplan-Meier analysis demonstrated a better survival rate in CR group patients without a 50 % increase in sCr (p = 0.024).

Conclusions

Among IgAN patients treated with Pozzi’s regimen, CR within 2 years predicts a good prognosis.

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Acknowledgments

This study was supported in part by a grant from the Study Group on IgA Nephropathy and by a Grant-in-Aid for Progressive Renal Diseases Research, Research on Intractable Disease, from the Ministry of Health, Labour and Welfare of Japan.

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Authors and Affiliations

  1. Department of Nephrology, Internal Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan

    Miho Tatematsu, Yoshinari Yasuda, Yoshiki Morita, Izumi Sakamoto, Naotake Tsuboi, Waichi Sato, Enyu Imai, Seiichi Matsuo & Shoichi Maruyama

  2. Department of Nephrology and Rheumatology, Tosei General Hospital, Aichi, Japan

    Kei Kurata

  3. Department of Nephrology, Kasugai Municipal Hospital, Aichi, Japan

    Tomohiko Naruse

  4. Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Osaka, Japan

    Rhohei Yamamoto

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  1. Miho Tatematsu
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  2. Yoshinari Yasuda
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  3. Yoshiki Morita
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  4. Izumi Sakamoto
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Correspondence to Yoshinari Yasuda.

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Tatematsu, M., Yasuda, Y., Morita, Y. et al. Complete remission within 2 years predicts a good prognosis after methylprednisolone pulse therapy in patients with IgA nephropathy. Clin Exp Nephrol 16, 883–891 (2012). https://doi.org/10.1007/s10157-012-0644-0

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  • DOI: https://doi.org/10.1007/s10157-012-0644-0

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