Clinical assessment of low-dose steroid therapy for patients with IgA nephropathy: a prospective study in a single center

Koike, Minako; Takei, Takashi; Uchida, Keiko; Honda, Kazuho; Moriyama, Takahito; Horita, Shigeru; Ogawa, Tetsuya; Yoshida, Takemi; Tsuchiya, Ken; Nitta, Kosaku

doi:10.1007/s10157-008-0036-7

Cited by 26 publications

(23 citation statements)

References 15 publications

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“…Proteinuria at the end of treatment or during follow-up was significantly lower in patients receiving steroid than in the control groups (five trials, 15,16,[20][21][22] (Figure 4).…”

Section: Effects On Proteinuriamentioning

confidence: 99%

“…The extracted data included baseline patient characteristics (age, gender, serum creatinine, GFR, proteinuria, BP), follow-up duration, mean proteinuria reduction, steroid doses and modalities of treatment, outcome events, and adverse events. Whenever data were not reported in the publications, [16][17][18] the primary review investigators (J. Lv and D. Xu) contacted the study authors to seek the missing data.…”

Section: Data Extraction and Quality Assessmentmentioning

confidence: 99%

“…The characteristics of the included studies are summarized in Table 1. Among them, one study (34 patients) included patients mainly with proteinuria in the nephrotic range, 15 six studies [17][18][19][20][21]23,24 (435 patients) included patients with proteinuria 1-3.5 g/d, and two trials 16,22 (67 patients) included those with proteinuria ,1 g/d. Most studies [17][18][19][22][23][24] (five studies with 356 patients) recruited patients with serum creatinine ,1.5 mg/dl or estimated GFR .50 ml/min per 1.73 m 2 .…”

Section: Trial Flow and Study Characteristicsmentioning

confidence: 99%

“…Of these, 78 were reviewed in full-text form; 9 RCTs, reported in 10 publications, [15][16][17][18][19][20][21][22][23][24] were identified as suitable for inclusion in this study. The reasons for exclusion are listed in Figure 1.…”

Section: Trial Flow and Study Characteristicsmentioning

confidence: 99%

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Corticosteroid Therapy in IgA Nephropathy

Perkovic

et al. 2012

Journal of the American Society of Nephrology

172

110

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The benefits and risks of steroids for the treatment of IgA nephropathy remain uncertain. We systematically searched MEDLINE, EMBASE, and the Cochrane Library for randomized, controlled trials of corticosteroid therapy for IgA nephropathy published between 1966 and March 2011. We identified nine relevant trials that included 536 patients who had urinary protein excretion .1 g/d and normal renal function. Forty-six (8.6%) of these patients developed a kidney failure event, defined as doubling of the serum creatinine/halving of the GFR or ESRD. Overall, steroid therapy was associated with a lower risk for kidney failure (relative risk, 0. , with no evidence of heterogeneity in these outcomes. Subgroup analysis suggested that the dose modifies the effect of steroids for renal protection (P for heterogeneity=0.030): Relatively high-dose and short-term therapy (prednisone .30 mg/d or high-dose pulse intravenous methylprednisolone with duration #1 year) produced significant renal protection, whereas low-dose, long-term steroid use did not. Steroid therapy was associated with a 55% higher risk for adverse events. The quality of included studies was low, however, limiting the generalizability of the results. In conclusion, steroids appear to provide renal protection in patients with IgA nephropathy but increase the risk for adverse events. Reliably defining the efficacy and safety of steroids in IgA nephropathy requires a high-quality trial with a large sample size.

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“…Proteinuria at the end of treatment or during follow-up was significantly lower in patients receiving steroid than in the control groups (five trials, 15,16,[20][21][22] (Figure 4).…”

Section: Effects On Proteinuriamentioning

confidence: 99%

Section: Data Extraction and Quality Assessmentmentioning

confidence: 99%

Section: Trial Flow and Study Characteristicsmentioning

confidence: 99%

Section: Trial Flow and Study Characteristicsmentioning

confidence: 99%

See 2 more Smart Citations

Corticosteroid Therapy in IgA Nephropathy

Perkovic

et al. 2012

Journal of the American Society of Nephrology

172

110

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“…In a Japanese RCT, Katafuchi et al (2003) reported the limitation of the low-dose PSL therapy, with an initial dose of 20 mg daily, to prevent the progression of IgAN. We have reported finding that low-dose PSL was effective in decreasing proteinuria during 2-year treatment period (Koike et al 2008). Six trials (341 patients) were considered to have been of sufficient quality to be included in a meta-analysis of immunosuppressive therapy for IgAN (Samuels et al 2004).…”

Section: ) Oral Steroid Therapymentioning

confidence: 99%

Tonsillectomy and Steroid Pulse Therapy for IgA Nephropathy

Moriyama

Nitta

2011

Tohoku J. Exp. Med.

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IgA nephropathy (IgAN) is the common cause of primary glomerulonephritis worldwide. The clinical course of IgAN is extremely variable and ranges from asymptomatic microscopic hematuria to rapidly progressive renal failure. The pathogenetic mechanisms of IgAN are still unclear, but a hypothesis consisting of two pathways has been proposed. The first pathway is continuous antigenic stimulation of the innate immune system by the tonsillar mucosa via the mucosa-bone marrow axis. In the second pathway, the anomalous stimulated immune response in the bone marrow results in the production of aberrantly glycosylated IgA1 and its subsequent deposition within the mesangial area. Based on the hypothesis, tonsillectomy plus steroid pulse therapy were introduced. A recent meta-analysis showed that tonsillectomy with or without steroid pulse therapy resulted in clinical remission with favorable long-term efficacy in IgAN patients. Tonsillectomy plus steroid pulse therapy now seems to be an effective treatment for IgAN patients with hematuria and minimal proteinuria, and it is more effective in patients with less severe histological findings. The efficacy of the combination therapy depends on the duration of the IgAN. Randomized, controlled trials are needed to examine the efficacy of tonsillectomy plus steroid pulse therapy in different clinical stages of IgAN.

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Immunosuppressive agents for treating IgA nephropathy

Vecchio

Bonerba

Palmer

et al. 2015

Cochrane Database of Systematic Reviews

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The optimal management of IgAN remains uncertain although corticosteroid therapy may lower the risks of kidney disease progression and need for dialysis or transplantation. Evidence for treatment effects of immunosuppressive agents on mortality, infection, and cancer is generally sparse or low-quality and insufficient to guide clinical practice. Available RCTs are few, small, have high risk of bias - particularly selective reporting - and generally do not systematically identify treatment-related harms. Subgroup analyses to identify specific patient characteristics that might predict better response to therapy were not possible. Larger placebo-controlled studies of corticosteroid therapy or mycophenolate mofetil which are sufficiently powered to evaluate patient-relevant end points including adverse events and that examine the optimal duration of treatment are now required in populations with IgAN with a range of kidney function.

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Clinical assessment of low-dose steroid therapy for patients with IgA nephropathy: a prospective study in a single center

Abstract: Our data suggested that low-dose steroid therapy for IgAN patients with mild inflammatory lesions could reduce the amount of urinary protein excretion and prevent deterioration of renal function, provided the histological findings in the renal biopsies showed mild vascular lesions.

Cited by 26 publications

References 15 publications

Corticosteroid Therapy in IgA Nephropathy

Corticosteroid Therapy in IgA Nephropathy

Tonsillectomy and Steroid Pulse Therapy for IgA Nephropathy

Immunosuppressive agents for treating IgA nephropathy

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