Corticosteroids in IgA nephropathy: a randomised controlled trial

Pozzi, Claudio; Bolasco, Piergiorgio; Fogazzi, G.B.; Andrulli, Simeone; Altieri, Paolo; Ponticelli, Claudio; Locatelli, Francesco

doi:10.1016/s0140-6736(98)03563-6

Cited by 456 publications

(391 citation statements)

References 18 publications

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“…There is a possibility that the proteinuria level at (20 -28). In a notable study, an Italian prospective RCT demonstrated that a 6-month course of steroid treatment protected against deterioration of renal function during follow-up (20). The long-term follow-up data of the trial showed that corticosteroids significantly reduced proteinuria and protected against renal function deterioration (21).…”

Section: Discussionmentioning

confidence: 99%

Long-Term Results of a Randomized Controlled Trial in Childhood IgA Nephropathy

Kamei¹,

Nakanishi

Ito³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Children with IgA nephropathy showing diffuse (Ͼ80%) mesangial proliferation are at high risk for end-stage renal failure (ESRF). A previous controlled trial showed that combination therapy consisting of prednisolone, azathioprine, heparin-warfarin, and dipyridamole early in the course of disease reduces immunologic renal injury and prevents the progression of sclerosed glomeruli. The objective of this study was to evaluate the long-term effectiveness of combination therapy in children with IgA nephropathy showing diffuse mesangial proliferation.Design, setting, participants, & measurements A secondary analysis of a multicenter, randomized, controlled trial involving 78 children with IgA nephropathy who received either 2-year combination therapy or heparin-warfarin and dipyridamole (control) therapy was conducted.Results The median duration of observation was 10 years (range, 0.5 to 18). Two of 40 patients (5%) who received combination therapy and five of 34 patients (14.7%) who received control therapy developed ESRF. A Kaplan-Meier plot of renal survival showed that the outcomes of patients in the combined therapy group were better than those in the control therapy group (log-rank P ϭ 0.03). The 10-year renal survival probability of each group was 97.1% (95% confidence interval, 81.4 to 99.6%) and 84.8% (95% confidence interval, 55.4 to 95.5%), respectively. The Cox proportional hazards model showed that the 2-year combination therapy was significantly associated with renal survival in both univariate and multivariate analyses.Conclusions Two-year combination therapy not only ameliorated the activity of the acute phase of nephritis but also improved the long-term outcome of severe childhood IgA nephropathy.

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Section: Discussionmentioning

confidence: 99%

Long-Term Results of a Randomized Controlled Trial in Childhood IgA Nephropathy

Kamei¹,

Nakanishi

Ito³

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…The kidney disease improving global outcomes (KDIGO) guidelines regarding IgA nephropathy suggest that the use of systemic glucocorticoids in patients who have >1 g of urinary protein excretion per day and estimated glomerular filtration rate (eGFR) higher than 50 ml/min/1.73 m 2 despite supportive care (2,3). This is based on few randomized controlled trials (4)(5)(6)(7)(8). Ballardie et al showed that immunosuppressive combination therapy stabilized eGFR in patients with an aggressive course of IgA nephropathy (9).…”

Section: Introductionmentioning

confidence: 99%

“…The role of steroid usage in addition to supportive care is not well studied in patients with eGFR < 50 mL/min/1.73 m 2 . The KDIGO guidelines make no recommendations for use of corticosteroids (CS) in individuals with an initial eGFR ≤50 mL/min/1.73 m 2 , who are under-represented in majority of the trials (3)(4)(5)(6)(7)(8)(9)(10). The recent analysis from VALIGA study showed that steroids may be of benefit even in this group (11).…”

Section: Introductionmentioning

confidence: 99%

Role of corticosteroid therapy in IgA nephropathy; where do we stand?

et al. 2017

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“…The benefits of corticosteroid monotherapy for the treatment of IgAN have been elucidated in several studies (7,13,14) and suggested in the KDIGO guidelines. However, an additional randomly controlled trial conducted in Japan showed that corticosteroid monotherapy was not beneficial for protecting kidney function (15).…”

Section: Discussionmentioning

confidence: 99%

“…Treatment with glucocorticoids alone or combined therapy with glucocorticoids and other immunosuppressive agents have shown beneficial effects by reducing proteinuria and improving renal function (7,8). According to the guidelines ‘Kidney Disease: Improving Global Outcomes’ (KDIGO) (9), which are based on the results of previous studies (7,10,11), patients with persistent proteinuria of >1 g/day following 6 months of treatment with renin-angiotensin system (RAS) inhibitors are suggested to receive a 6-month course of corticosteroid therapy. However, certain issues require clarification, including whether immunomodulatory treatment should be continued or withdrawn in patients with proteinuria of <1 g/day following 6 months of corticosteroid treatment, and whether the complete resolution of proteinuria is equivalent to the disappearance of renal active lesions.…”

Section: Introductionmentioning

confidence: 99%

Continuation of immunosuppressive treatment may be necessary in IgA nephropathy patients with remission of proteinuria: Evaluation by repeat renal biopsy

Luo

Yao

et al. 2013

Experimental and Therapeutic Medicine

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The present study aimed to evaluate the effects of an individualized, low-dose multi-drug immunosuppressive regimen for the treatment of immunoglobulin A nephropathy (IgAN). A preliminary investigation of the course of IgAN following immunosuppressive treatment was conducted based on repeat renal biopsies. Clinical and pathological data of 17 patients with IgAN who received repeat renal biopsies were analyzed retrospectively. In addition to basic treatment, 16 patients regularly received an individualized low-dose immunosuppressive regimen according to their clinical manifestations and pathological patterns following the first biopsy. Clinical parameters, including 24-h urinary protein excretion and levels of serum albumin, uric acid and total cholesterol were collected. Glomerular deposits of IgA and C3, as well as the activity and chronicity indexes of renal lesions were evaluated by semi-quantitative methods. The 24-h urinary protein excretion of the patients decreased significantly from the first biopsy (2.53±2.17 g/day) to the repeated biopsy (0.26±0.55 g/day) (P<0.001). Deposits of IgA and C3 in the glomerulus were persistent, but were reduced in quantity at the second biopsy. Although active renal lesions were observed in the majority of patients, the activity index decreased significantly from 3.18±1.33 prior to therapy to 2.47±0.80 following therapy (P<0.05), while the chronicity index did not change significantly (2.59±2.00 versus 2.76±1.89, respectively). The individualized, low-dose multi-drug immunosuppressive regimen used in the present study significantly minimized proteinuria, stabilized renal function and alleviated histological lesions in patients with IgAN without causing overt adverse effects during the short-term follow-up. In addition to proteinuria, renal pathological changes should be appraised when considering the withdrawal of immunosuppressants from IgAN treatment.

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Corticosteroids in IgA nephropathy: a randomised controlled trial

Cited by 456 publications

References 18 publications

Long-Term Results of a Randomized Controlled Trial in Childhood IgA Nephropathy

Long-Term Results of a Randomized Controlled Trial in Childhood IgA Nephropathy

Role of corticosteroid therapy in IgA nephropathy; where do we stand?

Continuation of immunosuppressive treatment may be necessary in IgA nephropathy patients with remission of proteinuria: Evaluation by repeat renal biopsy

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