Steroids and azathioprine in the treatment of IgA nephropathy

Stangou, Maria; Ekonomidou, Domniki; Giamalis, Panagiotis; Liakou, Helen; Tsiantoulas, Apostolis; Pantzaki, Afroditi; Papagianni, Aikaterini; Efstratiadis, George; Alexopoulos, Efstathios; Memmos, Dimitrios
June 2011
Clinical & Experimental Nephrology;Jun2011, Vol. 15 Issue 3, p373
Academic Journal
im: IgA nephropathy (IgAN) is a very common glomerulonephritis among young adults, but the best therapeutic approach has not been fully elucidated. This study evaluated the effect of two different treatment regimes in IgAN, steroids alone or in combination with azathioprine. Methods: Among 122 patients with primary IgA nephropathy diagnosed in the 2000-2007 period, 22 fulfilled the inclusion criteria for the study: estimated glomerular filtration rate (eGRF) ≥30 ml/min/1.73 m, urine protein (Upr) ≥1 g/24 h, blood pressure (BP) <130/80 mmHg, and previous treatment with renin-angiotensin system inhibitors (RAASi) and polyunsaturated fatty acids (PFA) for at least 6 months. Patients were randomized to receive either methylprednisolone alone (MP group) or MP in combination with azathioprine (MP + Aza group) for 12 months, while treatment with RAASi + PFA continued unchanged in both groups. Results: At the completion of the trial, renal function in the MP group remained stable, eGFR from 52 ± 26.7 to 53.6 ± 27.3 ml/min/1.73 m, p = NS, and Upr decreased from 2.4 ± 0.9 to 0.8 ± 0.5 g/24 h, p < 0.001. In the MP + Aza group, eGFR slightly increased from 57.4 ± 28.7 to 66 ± 31 ml/min/1.73 m, p = NS, and Upr decreased from 2.4 ± 1 to 0.7 ± 0.7 g/24 h, p < 0.001. Four patients from the MP group with partial remission at the end of the trial had a complete response when converted to Aza. Eleven patients (5 from the MP and 6 from the MP + Aza group) relapsed after stopping treatment and were restarted on lower doses. Conclusions: Both, steroid treatment alone and steroids in combination with azathioprine seem to be effective in reducing the severity of proteinuria and stabilizing renal function in IgAN. Patients who do not respond to steroids may have a better response with the combination of steroids and azathioprine.


Related Articles

  • Validation of the Oxford classification of IgA nephropathy in cohorts with different presentations and treatments. Coppo, Rosanna; Troyanov, Stéphan; Bellur, Shubha; Cattran, Daniel; Cook, H Terence; Feehally, John; Roberts, Ian S D; Morando, Laura; Camilla, Roberta; Tesar, Vladimir; Lunberg, Sigrid; Gesualdo, Loreto; Emma, Francesco; Rollino, Cristiana; Amore, Alessandro; Praga, Manuel; Feriozzi, Sandro; Segoloni, Giuseppe; Pani, Antonello; Cancarini, Giovanni // Kidney International;Oct2014, Vol. 86 Issue 4, p828 

    The Oxford Classification of IgA Nephropathy (IgAN) identified mesangial hypercellularity (M), endocapillary proliferation (E), segmental glomerulosclerosis (S), and tubular atrophy/interstitial fibrosis (T) as independent predictors of outcome. Whether it applies to individuals excluded from...

  • Comparison of inhibitors of renin-angiotensin-aldosterone system (RAS) and combination therapy of steroids plus RAS inhibitors for patients with advanced immunoglobulin A nephropathy and impaired renal function. Moriyama, Takahito; Nakayama, Kayu; Ochi, Ayami; Amemiya, Nobuyuki; Tsuruta, Yuki; Kojima, Chiari; Itabashi, Mitsuyo; Takei, Takashi; Uchida, Keiko; Nitta, Kosaku // Clinical & Experimental Nephrology;Apr2012, Vol. 16 Issue 2, p231 

    Background: The adaptation of steroid therapy and the effect of renin-angiotensin-aldosterone system inhibitors (RASIs) for advanced immunoglobulin A nephropathy (IgAN) patients with impaired renal function are still controversial. Methods: We divided 63 IgAN patients with an estimated...

  • Complete remission within 2 years predicts a good prognosis after methylprednisolone pulse therapy in patients with IgA nephropathy. Tatematsu, Miho; Yasuda, Yoshinari; Morita, Yoshiki; Sakamoto, Izumi; Kurata, Kei; Naruse, Tomohiko; Yamamoto, Rhohei; Tsuboi, Naotake; Sato, Waichi; Imai, Enyu; Matsuo, Seiichi; Maruyama, Shoichi // Clinical & Experimental Nephrology;Dec2012, Vol. 16 Issue 6, p883 

    Background: Pozzi et al. reported the effectiveness of steroid pulse therapy (Pozzi's regimen) in IgA nephropathy (IgAN). The present study was performed to clarify the predictive factors for IgAN patients treated with Pozzi's regimen. Methods: One hundred nine IgAN patients treated by Pozzi's...

  • Effect of treatment on urinary kidney injury molecule-1 in IgA nephropathy. Mi Seon Seo; Moo Yong Park; Soo Jeong Choi; Jin Seok Jeon; Hyunjin Noh; Jin Kuk Kim; Dong Cheol Han; Seung Duk Hwang; So Young Jin; Soon Hyo Kwon // BMC Nephrology;2013, Vol. 14 Issue 1, p1 

    Background: Kidney injury molecule-1 (KIM-1) is a biomarker useful for detecting early tubular damage and has been recently reported as a useful marker for evaluating kidney injury in IgA nephropathy (IgAN). We therefore investigated whether treatment decreases urinary KIM-1 excretion in IgAN....

  • Effect of hematuria on the outcome of IgA nephropathy with mild proteinuria. Tanaka, Kayu; Moriyama, Takahito; Iwasaki, Chihiro; Takei, Takashi; Nitta, Kosaku // Clinical & Experimental Nephrology;Oct2015, Vol. 19 Issue 5, p815 

    Background: The effects of hematuria on the outcome of IgA nephropathy (IgAN) remain unknown and treatment of IgAN with severe hematuria is controversial. Methods: Eighty-eight IgAN patients with proteinuria <0.5 g/day and who had not received corticosteroids, immunosuppressive agents, or...

  • Infantile Immunoglobulin A Nephropathy Showing Features of Membranoproliferative Glomerulonephritis. Kurosu, Akira; Oka, Noriko; Hamaguchi, Takeshi; Yoshikawa, Norishige; Joh, Kensuke // Tohoku Journal of Experimental Medicine;Nov2012, Vol. 228 Issue 3, p253 

    Immunoglobulin A nephropathy (IgAN) showing predominant IgA and complement 3 (C3) deposition on the mesangium is an immune complex-mediated glomerulonephritis. This renal disease is the most common primary glomerular disease worldwide. However, infantile onset of IgAN is rare. In the present...

  • Estimated glomerular filtration rate and daily amount of urinary protein predict the clinical remission rate of tonsillectomy plus steroid pulse therapy for IgA nephropathy. Suzuki, Keisuke; Miura, Naoto; Imai, Hirokazu // Clinical & Experimental Nephrology;Aug2014, Vol. 18 Issue 4, p606 

    Background: This retrospective study was designed to estimate the clinical remission (CR) rate of tonsillectomy plus steroid pulse (TSP) therapy in patients with IgA nephropathy. Methods: Based on 292 of 302 patients with IgA nephropathy treated at 11 Japanese hospitals, we constructed heat maps...

  • Optimal Proteinuria Target for Renoprotection in Patients with IgA Nephropathy. Nam, Ki Heon; Kie, Jeong Hae; Lee, Mi Jung; Chang, Tae-Ik; Kang, Ea Wha; Kim, Dong Wook; Lim, Beom Jin; Park, Jung Tak; Kwon, Young Eun; Kim, Yung Ly; Park, Kyoung Sook; An, Seong Yeong; Oh, Hyung Jung; Yoo, Tae-Hyun; Kang, Shin-Wook; Choi, Kyu Hun; Jeong, Hyeon Joo; Han, Dae-Suk; Han, Seung Hyeok // PLoS ONE;Jul2014, Vol. 9 Issue 7, p1 

    Background: Proteinuria is a target for renoprotection in kidney diseases. However, optimal level of proteinuria reduction in IgA nephropathy (IgAN) is unknown. Methods: We conducted a retrospective observational study in 500 patients with biopsy-proven IgAN. Time-averaged proteinuria (TA-P) was...

  • Combined treatment with renin-angiotensin system blockers and polyunsaturated fatty acids in proteinuric IgA nephropathy: a randomized controlled trial. Pietro Manuel Ferraro; Gian Franco Ferraccioli; Giovanni Gambaro; Pierluigi Fulignati; Stefano Costanzi // Nephrology Dialysis Transplantation;Jan2009, Vol. 24 Issue 1, p156 

    Background. Currently, several therapeutic protocols exist for IgA nephropathy (IgAN); results in slowing the progression to end-stage renal disease (ESRD) are variable, but ∼30–40% of patients require replacement therapy (dialysis or renal transplantation) by 20 years from the...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics