A digest from evidence-based clinical practice guideline for IgA nephropathy 2020

Suzuki, Hitoshi; Kikuchi, Masao; Koike, Kentaro; Komatsu, Hiroyuki; Matsuzaki, Keiichi; Takahashi, Kazuo; Ichikawa, Daisuke; Okabe, Masahiro; Obata, Yoko; Katafuchi, Ritsuko; Kihara, Masao; Kohatsu, Kaori; Sasaki, Takaya; Shimizu, Akihiro; Nakanishi, Koichi; Fukuda, Akira; Miyazaki, Yoichi; Muto, Masahiro; Yanagawa, Hiroyuki; Suzuki, Yusuke; Fujimoto, Shoichi; Furuichi, Kengo; Okada, Hirokazu; Narita, Ichiei

doi:10.1007/s10157-021-02095-8

Cited by 13 publications

(15 citation statements)

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“…IgA nephropathy is a common pediatric nephropathy causing chronic glomerulonephritis. The recommended treatment for pediatric patients with active IgA nephropathy is angiotensin-converting enzyme inhibitors for at least 2 years in mild cases, and multiple-drug combination therapy (cocktail therapy) comprising corticosteroids, immunosuppressive agents, and angiotensin-converting enzyme inhibitors for 2 years in severe cases 1) . On the other hand, steroid-use has various side effects, especially steroid myopathy, resulting in a decline in physical functioning 2) .…”

Section: Introductionmentioning

confidence: 99%

Exercise therapy during hospitalization for a pediatric patient with active IgA nephropathy: A case report

Tabata

Yabe

Mitake

et al. 2023

Nihon Shoni Jinzobyo Gakkai Zasshi

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Exercise therapy for pediatric patients with active IgA nephropathy is necessary to improve physical mobility functioning and maintaining a normal daily and school-life, whilst managing the risk of further relapse; although, this has not been investigated yet. This case report aimed to evaluate the influence of exercise therapy in a pediatric patient with active IgA nephropathy whilst being treated in-hospital with a multiple-drug combination therapy. The patient was an 18-year-old girl diagnosed with IgA nephropathy a year prior to her admission at the hospital for multiple-drug combination therapy.Moderate-intensity exercise therapy was started on the 8th day and continued until the 31st day, at discharge. The results of her physical functioning on the 8th and 30th day were grip strength from 21.1 kg to 21.0 kg, knee extension strength from 0.59 kgf/kg to 0.74 kgf/kg, skeletal muscle mass index from 7.2 kg/m 2 to 6.7 kg/m 2 , 6-minute walk test from 570 m to 590 m, and peak work rate from 100 watts to 110 watts.Muscle strength and exercise tolerance were maintained, or improved. The urine protein/creatinine ratio (UP/Cr) from the 8th day to discharge decreased from 0.4 g/gCr to 0.2 g/gCr.There was no recurrence of IgA nephropathy during hospitalization. Exercise therapy during hospitalization in a pediatric patient with active IgA nephropathy may not have adverse effects, and may prevent a decline in physical function and exercise tolerance.

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Section: Introductionmentioning

confidence: 99%

Exercise therapy during hospitalization for a pediatric patient with active IgA nephropathy: A case report

Tabata

Yabe

Mitake

et al. 2023

Nihon Shoni Jinzobyo Gakkai Zasshi

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Section: Introductionmentioning

confidence: 99%

“…IgA nephropathy (IgAN) is the most common primary glomerular disease of the global population, which has become an important cause of end-stage renal disease (ESRD) [ 1 , 2 ]. Pathologically, autoimmunity has been recognized as a major mechanism underlying the pathogenesis and progression of IgAN [ 1 , 3 ]. Accordingly, various immunosuppressants have been applied to prevent the deterioration of renal function and attenuate the proteinuria in patients with IgAN [ 4–8 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of leflunomide combined with corticosteroids for the treatment of IgA nephropathy: a Meta-analysis of randomized controlled trials

Ming

2022

Renal Failure

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Objective We performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of leflunomide combined with corticosteroids, compared with corticosteroids alone, for IgA nephropathy. Materials and methods Studies were retrieved by searching of PubMed, Embase, Cochrane’s Library, China National Knowledge Infrastructure (CNKI), and Wanfang databases on 11 October 2021. A random-effect model incorporating the heterogeneity was used to pool the results. The efficacy outcomes included the complete remission rate of proteinuria, overall response rate (the combined rates of patients with complete and partial remission of proteinuria), changes of urine protein excretion (UPE), serum creatinine (SCr), and estimated glomerular infiltrating rate (eGFR). Results Nineteen studies were included. Patients receiving the combined therapy had a higher complete remission rate (relative risk [RR]: 1.29, 95% CI: 1.08–1.55, p = 0.006; I 2 = 0%) and overall response rate (RR: 1.18, 95% CI: 1.10–1.26, p < 0.001, I 2 = 0%) compared to patients who received CS alone. Besides, combined therapy was associated with significantly reduced levels of UPE (mean difference [MD]: −0.30 g/24h, 95% CI: −0.43 to −0.16, p < 0.001; I 2 = 34%) and SCr (MD: −7.55 mmol/L, 95% CI: −11.06 to −4.04, p < 0.001; I 2 = 34%), and increased level of eGFR (MD: 6.51 mL/min/1.73 m 2 , 95% CI: 4.06–8.97, p < 0.001; I 2 = 0%). The incidence of adverse events was not significantly different. Conclusions Combined treatment with leflunomide and corticosteroids was more effective than corticosteroids alone for patients with IgA nephropathy.

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“…Further, corticosteroids and immunosuppressive drugs are used for patients at high risk of progressive kidney disease despite the above treatments. In some Asian countries, palatine tonsillectomy (plus steroid pulse therapy), antiplatelet drugs, and n-3 fatty acids (fish oils) are also used (1). Treatment with corticosteroids is the gold standard for IgA nephropathy with high risk of disease progression, but there is no established treatment regimen for patients who are refractory to steroid therapy.…”

Section: Introductionmentioning

confidence: 99%

Protocol for a Phase 1, Open-Label, Multiple-Center, Dose-Escalation Study to Evaluate the Safety and Tolerability of ADR-001 in the Treatment of Immunoglobulin A Nephropathy

Tanaka

Furuhashi²,

Fujieda³

et al. 2022

Front. Med.

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IntroductionImmunoglobulin A (IgA) nephropathy is a disease that presents with urinary symptoms such as glomerular hematuria and urinary protein positivity, with predominant deposition of IgA in the mesangial region of the glomerulus. Corticosteroids are mainly used for treatment; however, infection is a serious adverse event, and evidence regarding therapeutic efficacy is insufficient, thus new treatments are strongly desired. Mesenchymal stem cells (MSCs) contribute to the amelioration of inflammation and recovery of organ function in inflammatory environments by converting the character of leukocytes from inflammatory to anti-inflammatory and inducing the proliferation and differentiation of organ component cells, respectively. These properties of MSCs have led to their clinical application in various inflammatory diseases, but this study is the first clinical trial of MSCs for refractory glomerulonephritis in the world. This study is registered and assigned the number, jRCT2043200002 and NCT04342325.MethodsThis will be a phase 1, open-label, multiple-center, dose-escalation study of adult patients with refractory IgA nephropathy resistant to or difficult to treat with existing therapies. ADR-001 will be administered intravenously to from three to six patients at a dose of 1 × 108 cells once in the first cohort and to six patients twice at 2-week intervals in the second cohort, and observation will continue until 52 weeks. The primary endpoint will be the evaluation of adverse events up to 6 weeks after the start of ADR-001 administration. Secondary endpoints will be the respective percentages of patients with adverse events, clinical remission, partial remission, remission of urine protein, remission of hematuria, time to remission, changes in urine protein, hematuria, and estimated glomerular filtration rate.ResultsFollowing the administration of ADR-001 to patients with IgA nephropathy, the respective percentages of patients with adverse events, asymptomatic pulmonary emboli, clinical remission, partial remission, urine protein remission, hematuria remission, their time to remission, changes in urine protein, hematuria, and glomerular filtration rate will be determined.ConclusionThis study will evaluate the safety and tolerability of ADR-001 and confirm its therapeutic efficacy in adult patients with refractory IgA nephropathy.

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A digest from evidence-based clinical practice guideline for IgA nephropathy 2020

Cited by 13 publications

References 0 publications

Exercise therapy during hospitalization for a pediatric patient with active IgA nephropathy: A case report

Exercise therapy during hospitalization for a pediatric patient with active IgA nephropathy: A case report

Efficacy and safety of leflunomide combined with corticosteroids for the treatment of IgA nephropathy: a Meta-analysis of randomized controlled trials

Protocol for a Phase 1, Open-Label, Multiple-Center, Dose-Escalation Study to Evaluate the Safety and Tolerability of ADR-001 in the Treatment of Immunoglobulin A Nephropathy

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