Initial treatment with pulse methylprednisolone followed by short-term prednisolone and tonsillectomy for childhood IgA nephropathy.

Abstract

Although a combination therapy, comprising 2-year high-dose oral prednisolone (PSL), is effective for treating childhood immunoglobulin A nephropathy (IgAN), severe adverse effects and residual proteinuria occur in some patients after the therapy. To clarify the efficacy of intravenous pulse methylprednisolone (IVMP; 15-20mg/kg; maximum 600mg/day; for 3 consecutive days/week for 3weeks) followed by short-term reduced-dose PSL (initially 1mg/kg; maximum 30mg on alternate days; tapered off within approximately 12months) and tonsillectomy as an initial treatment, we retrospectively reviewed the clinical courses of 54 consecutive children with IgAN (32 boys; mean age at onset, 12.2years; follow-up period of > 2years) after initiating the treatment. According to the Japanese pediatric IgAN guidelines, we divided the 54 patients into the following two groups: group 1, comprising 24 patients with severe IgAN, and group 2, comprising 30 patients with mild IgAN. After the treatment, proteinuria disappeared in all patients at a median of 1.6months (group 1, 2.8 months; group 2, 0.4months) and hematuria disappeared in 47 patients (87%) at a median of 13.2months (group 1, 15.9 months; group 2, 13.2months). During the follow-up period (median 5years), no severe adverse effects were observed in any patient. At the last visit, although two patients (4%) had mild proteinuria, none developed hypertension or renal insufficiency. As an initial treatment, IVMP followed by short-term PSL and tonsillectomy appears to be effective for treating childhood IgAN.