Recent Therapeutic Strategies Improve Renal Outcome in Patients with IgA Nephropathy

Abstract

Background/Aims: Various treatment options for IgA nephropathy (IgAN) have been developed, particularly over the past decade. Nevertheless, whether such therapeutic interventions improve actual renal outcome as compared with previous therapies remains obscure. Methods: We examined data from 304 patients with IgAN whose serum creatinine value at renal biopsy was <2.0 mg/dl and who had been followed up for >12 months. We assigned the patients to groups according to the period of diagnosis (group E, between 1981 and 1995, n = 130; group L, between 1996 and 2006, n = 174). Results: Significantly more patients had received steroid therapy and renin-angiotensin system inhibitors (RAS-I) in group L than in group E (steroid 51.7 vs. 15.4%, p < 0.001; RAS-I 42.0 vs. 1.5%, p < 0.001). Forty patients overall reached end-stage renal disease (ESRD) within 81.9 ± 55.1 months of observation. Kaplan-Meier analysis showed that the 10-year renal survival rate of group L persisted and significantly differed from that of group E (95.7 vs. 75.2%, p = 0.005). The Cox proportional hazards model adjusted for known prognostic markers demonstrated that initial therapeutic interventions in group L prevented ESRD, with a hazard ratio of 0.29 (95% CI 0.11–0.76, p = 0.011). Conclusion: Although this study is not a prospective trial, our results indicate that aggressive therapeutic intervention for IgAN over the past decade has improved actual renal outcome.

Corticotherapy response in primary IgA nephropathy

“…24 In this study, the treated group showed a lower estimated GFR at baseline compared to control group. However, the treated group that was expected to have the worst prognosis, [25][26][27] had a significant reduction of proteinuria levels.…”

“…However, prospective, randomized controlled trials to evaluate treatment of primary IgA nephropathy are few, and most studies have used approaches similar to the present study. 27 Finally, the present study focused on the effects during the first 12 months of treatment, and this time is not long enough to study the efficiency of this treatment to preserve renal function. For this effect would be necessary 5 to 10 years of follow-up.…”

“…Indeed, a retrospective study found patients followed-up from 1996 through 2006 had higher renal survival rates than those followed-up before 1995. 27 This difference was attributed to the more intensive use of the renin-angiotensin inhibitors and corticosteroid therapy in the more recently followed-up group. Using a multivariate model, it has been demonstrated that proteinuria together with high serum creatinine and histological severity at clinical presentation are independent risk factors.…”

“…Using a multivariate model, it has been demonstrated that proteinuria together with high serum creatinine and histological severity at clinical presentation are independent risk factors. 27 During analysis of another study of Pozzi et al, 24 which reported that the addition of azathioprine does not improve long-term renal survival in patients treated with the 6-month course of corticosteroid therapy, an editorial 16 considered it a limitation of the study that fewer than half of the patients received an ACE-inhibitor or ARB at baseline. According to the 2011 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Glomerulonephritis, optimization of supportive care before considering steroids or other immunosupressive agents is recommended unless the patient shows a rapidly progressive disease course.…”

Identification of Serum Anti-GADD34 Antibody as a Common Marker of Diabetes Mellitus and Parkinson Disease

“…Samples from patients with aCI were obtained from Chiba Prefectural Sawara Hospital. Samples from patients with CKD were from the Kumamoto cohort [15,16].…”