Abstract
To compare the long-term efficacy of corticosteroids (P) alone or in combination with cyclophosphamide (CTX), leflunomide (LEF), or Angiotensin-convertase inhibitors or angiotensin II receptor blockers (ACEI/ARB) in treatment for IgA nephropathy (IgAN), 311 patients with IgAN were identified. Therapeutic effectiveness (including progression, partial remission, complete remission) and combined renal endpoint (defined as 30% reduction in eGFR or ESRD) were compared based on different therapies. After immunosuppressive and ACEI/ARB treatment, the levels of eGFR, proteinuria and albumin were significantly improved at the last follow-up, the extent of improvement of eGFR, proteinuria, and albumin was more notable in P + CTX group and P + LEF group. 41%, 52.2%, 55.3% and 55.2% in P + CTX, P + LEF, P and ACEI/ARB group achieved complete remission, respectively. Multivariate regression analysis indicated that only proteinuria (Relative risk (RR) 0.82(0.72–0.94), P = 0.004) and tubular atrophy/interstitial fibrosis (RR 0.26(0.13–0.57), P = 0.001) were predictors for complete remission. The optimal cutoffs of eGFR was 47.085 ml/min/1.73 m2 predicting renal function recovery in P + CTX therapy. In conclusion, tubular atrophy/interstitial fibrosis and massive proteinuria were poor predictors for complete remission in IgAN, it appears as though patients may have benefited from immunosuppressive treatment but that comparison to a well-matched contemporary control group or, ideally, a randomized controlled clinical trial, would be required to show this.
Highlights
Immunoglobin A nephropathy (IgAN) is the most frequent primary glomerulonephritis worldwide, especially in China
IgA nephropathy has remained the most common form of primary glomerulonephritis leading to chronic kidney disease in developed countries
Identification of high-risk patients and who may benefit from immunosuppressive treatment is important[27,28,29,30]
Summary
Immunoglobin A nephropathy (IgAN) is the most frequent primary glomerulonephritis worldwide, especially in China. It accounts for approximately 40–50% of primary glomerulonephritis[1,2]. IgAN has various clinical and pathological manifestations and corresponding considerable variations in prognosis. It is a relatively benign disease, the long term prognosis should not be considered mild, because, after 20 years of disease progression, 20–50% of the patients reach end stage renal disease[3,4,5,6]. We retrospectively analyzed 311 patients with IgAN treated with CTX, LEF, P or conservative management alone in our center to identify long-term therapeutic effectiveness and renal outcome, and explore the prognostic factors for renal function recovery in patients with reduced renal function
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