Comparison of inhibitors of renin–angiotensin–aldosterone system (RAS) and combination therapy of steroids plus RAS inhibitors for patients with advanced immunoglobulin A nephropathy and impaired renal function

Moriyama, Takahito; Nakayama, Kayu; Ochi, Ayami; Amemiya, Nobuyuki; Tsuruta, Yuki; Kojima, Chiari; Itabashi, Mitsuyo; Takei, Takashi; Uchida, Keiko; Nitta, Kosaku

doi:10.1007/s10157-011-0545-7

Cited by 5 publications

(4 citation statements)

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“…Several previous reports from various countries have facilitated a full understanding of the renoprotective effects of RASIs (11)(12)(13). Results from our laboratory have also demonstrated the beneficial effects of these medications, especially in patients with advanced IgAN with an impaired renal function (19)(20)(21), a condition for which fish oil therapies, including the omega-3 polyunsaturated fatty acids (PUFA) eicosapentaenoic acid and docosahexaenoic acid (DHA), are also beneficial, as reported by several groups (22)(23)(24)(25). In an elegant series of studies, Donadio and colleagues reported the short-and long-term beneficial effects of fish oil on IgAN using a randomized controlled trial.…”

Section: Discussionsupporting

confidence: 56%

“…For example, the number of advanced cases involving T2 and T3 in the Oxford analysis tended to be higher in the DILAZEP group, and the ACEI/ARB ratio was also higher in the DI-LAZEP group. In our previous reports, we demonstrated the long-term beneficial effects of RASIs on the prevention of end-stage renal disease; however, we could not show any effects causing significant decreases in the levels of U-Prot in the advanced IgAN cases (20,21), and the decreases in the levels of U-Prot caused by ARBs were greater than those caused by ACEIs in these cases (19). In addition, we could not deny that these differences between the groups accounted for the lack of significant decreases in the levels of U-Prot in the DILAZEP group, although the ability of RASIs to decrease the levels of U-Prot is widely recognized.…”

Section: Discussionmentioning

confidence: 99%

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Effects of Combination Therapy with Renin-Angiotensin System Inhibitors and Eicosapentaenoic Acid on IgA Nephropathy

et al. 2013

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Objective The beneficial effects of renin-angiotensin-aldosterone system inhibitors (RASI) and the omega-3 polyunsaturated fatty acid eicosapentaenoic acid (EPA) on IgA nephropathy (IgAN) have been reported. However, it is unknown whether these agents have any synergistic interactions. Methods We divided 38 IgAN patients into two groups: an EPA group (n=18) treated with RASI plus EPA and a DILAZEP group (n=20) treated with RASI plus dilazep dihydrochloride. We analyzed the clinical and histological background of each patient, any relevant clinical findings obtained one year after treatment and any factors significantly related to decreases in proteinuria. Results The clinical findings were largely similar between the groups, except for body mass index (24.9± 4.5 in the EPA group vs. 21.4±2.1 in the DILAZEP group, p=0.0041) and total cholesterol (median: 206.0 vs. 177.5 mg/dL, p=0.0493). The histological findings, evaluated according to the Oxford classification, were also similar between the groups. At one year after treatment, the EPA group demonstrated a significantly decreased mean blood pressure (from 94.7±9.0 to 86.4±7.2 mmHg, p=0.0007) and a significantly decreased median level of proteinuria (from 0.80 to 0.41 g/g creatinine, p<0.001). In the DILAZEP group, the mean blood pressure significantly decreased (from 95.2±13.2 to 88.1±7.7 mmHg, p<0.001) without any significant decrease in the median level of proteinuria (from 0.88 to 0.60 g/g creatinine). According to a multivariate logistic analysis, EPA was found to be the only independent factor related to decreases in proteinuria (odds ratio = 5.073, 95% CI: 1.18-26.7, p=0.0285). Conclusion We conclude that EPA accelerates the effects of RASI and thus decreases the proteinuria observed in patients with IgAN.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Effects of Combination Therapy with Renin-Angiotensin System Inhibitors and Eicosapentaenoic Acid on IgA Nephropathy

et al. 2013

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“…Although slowly progressive over decades, IgAN is not a benign disease. Since IgAN was first described over 40 years ago, patients with this disease have been treated with oral steroids [4] , [14] , [15] , steroid pulse therapy [5] , [6] , tonsillectomy [7] , [16] , [17] , renin-angiotensin aldosterone system inhibitors [18] – [20] , eicosapentaenoic acid [21] , statins [22] and combinations of these agents [23] . Although these agents were found to improve short and intermediate term renal outcomes, less is known about very long term outcomes in these patients.…”

Section: Discussionmentioning

confidence: 99%

Prognosis in IgA Nephropathy: 30-Year Analysis of 1,012 Patients at a Single Center in Japan

et al. 2014

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BackgroundLittle is known about the long-term prognosis of patients with IgA nephropathy (IgAN).MethodsThis retrospective cohort analysis evaluated clinical and histological findings at the time of renal biopsy, initial treatment, patient outcomes over 30 years, and risk factors associated with progression in 1,012 patients diagnosed with IgAN at our center since 1974.ResultsOf the 1,012 patients, 40.5% were male. Mean patient age was 33±12 years and mean blood pressure was 122±17/75±13 mmHg. Mean serum creatinine concentration was 0.89±0.42 mg/dL, and mean estimated glomerular filtration rate (eGFR) was 78.5±26.2 ml/min/1.73 m2. Mean proteinuria was 1.19±1.61 g/day, and mean urinary red blood cells were 36.6±35.3/high-powered field. Histologically, mesangial hypercellularity was present in 47.6% of patients, endothelial hypercellularity in 44.3%, segmental sclerosis in 74.6%, and tubular atrophy/interstitial fibrosis in 28.8% by Oxford classification. Initial treatment consisted of corticosteroids in 26.9% of patients, renin-angiotensin-aldosterone system inhibitor in 28.9%, and tonsillectomy plus steroids in 11.7%. The 10-, 20-, and 30-year renal survival rates were 84.3, 66.6, and 50.3%, respectively. Tonsillectomy plus steroids dramatically improved renal outcome. Cox multivariate regression analysis showed that higher proteinuria, lower eGFR, and higher uric acid at the time of renal biopsy were independent risk factors for the development of end stage renal disease (ESRD).ConclusionsIgAN is not a benign disease, with about 50% of patients progressing to ESRD within 30 years despite treatment.

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“…The other important mechanism of deterioration of renal function is caused by which aberrantly glycosylated serum IgA1 causes mesangial IgA deposition and inflammatory changes, such as crescent formation and endothelial hyper cellularity in the glomeruli [2]. This can be treated by steroid therapy to suppress inflammatory changes in the glomeruli and interstitium [8] (Table 2). IgAN patients with persistent proteinuria ≥ 1g/d, despite optimized supportive care, should be given a 6-month course of corticosteroids if GFR is above 50 ml/min.…”

Section: Corticosteroidsmentioning

confidence: 99%

The Treatment of Primary IgA Nephropathy

Song¹

2013

J Nephrol Ther

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IgA Nephropathy (IgAN) is a very common glomerulonephritis worldwide, especially in Asia, which is an important cause of progressive kidney disease with 25-30% of patients developing end-stage renal disease within 20 years of diagnosis. IgA nephropathy can be in different age bracket onset, but mainly in adults. The treatment of primary IgA nephropathy we mentioned in this article is only for adults. The optimal treatment for IgAN remains poorly defined. The current treatment depends on the assessment of proteinuria, blood pressure, estimated Glomerular Filtration Rate (eGFR) and pathological features, including antiproteinuric and antihypertensive therapy, corticosteroids, immunosuppressive agents, fish oil and tonsillectomy. Compounded by the relative lack in IgAN of Randomized Controlled Trials (RCTs), there is no consensus on the use of corticosteroids, immunosuppressive agents, fish oil and tonsillectomy for treatment. The treatment of primary IgA Nephrology was reviewed from these aspects in this article.

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Comparison of inhibitors of renin–angiotensin–aldosterone system (RAS) and combination therapy of steroids plus RAS inhibitors for patients with advanced immunoglobulin A nephropathy and impaired renal function

Abstract: Combination therapy with steroids and RASIs was not superior to monotherapy with RASIs for advanced IgAN with impaired renal function.

Cited by 5 publications

References 18 publications

Effects of Combination Therapy with Renin-Angiotensin System Inhibitors and Eicosapentaenoic Acid on IgA Nephropathy

Effects of Combination Therapy with Renin-Angiotensin System Inhibitors and Eicosapentaenoic Acid on IgA Nephropathy

Prognosis in IgA Nephropathy: 30-Year Analysis of 1,012 Patients at a Single Center in Japan

The Treatment of Primary IgA Nephropathy

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