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
April 2012
Clinical & Experimental Nephrology;Apr2012, Vol. 16 Issue 2, p231
Academic Journal
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 glomerular filtration rate (eGFR) of <60 ml/min/1.73 m and proteinuria ≥ 0.5 g/day into two groups: the RASI group (RASI, n = 33), treated with RASIs alone; and the combination group (COMBI, n = 30), treated with corticosteroids and RASIs. We analyzed the clinical and histological background, renal survival rate, and the risk factors for progression. Results: Renal function (mean eGFR: COMBI 46.4 vs. RASI 47.0 ml/min/1.73 m), the amount of proteinuria (median: COMBI 1.39 vs. RASI 1.17 g/g creatinine) and histological backgrounds were not significantly different between the groups, but urinary red blood cells (U-RBCs) were significantly higher in the COMBI group than in the RASI group (median: COMBI 30.0 vs. RASI 10.0 counts/high-power field, P = 0.0171). The serial change in proteinuria did not differ until 5 years after treatment, but U-RBCs were significantly decreased in both groups ( P < 0.0001), and eGFR was significantly decreased in the RASI group ( P < 0.001) but not in the COMBI group. The results for each year after treatment did not differ significantly between both groups. The renal survival rate was not significantly different between the groups. There was no independent risk factor for progression by Cox regression analysis. Conclusion: Combination therapy with steroids and RASIs was not superior to monotherapy with RASIs for advanced IgAN with impaired renal function.


Related Articles

  • 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 // Clinical & Experimental Nephrology;Jun2011, Vol. 15 Issue 3, p373 

    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...

  • Effects of Hydroxychloroquine on Proteinuria in Immunoglobulin A Nephropathy. Yang, Ya-Zi; Liu, Li-Jun; Shi, Su-Fang; Wang, Jin-Wei; Chen, Yu-Qing; Lv, Ji-Cheng; Zhang, Hong // American Journal of Nephrology;Apr2018, Vol. 47 Issue 3, p145 

    Background: Hydroxychloroquine (HCQ) is a well-known immunomodulator that is useful as in the treatment for lupus because of its inhibitory effect on toll-like receptors and cytokines, which are speculated to play a role in the pathogenesis of Immunoglobulin A (IgA) nephropathy...

  • The impact of stopping inhibitors of the renin–angiotensin system in patients with advanced chronic kidney disease. Ahmed, Aimun K.; Kamath, Neetha S.; El Kossi, Mohsen; El Nahas, A. Meguid // Nephrology Dialysis Transplantation;Dec2010, Vol. 25 Issue 12, p3977 

    Background. Inhibition of the renin–angiotensin–aldosterone system (RAAS) has shown to slow chronic kidney disease (CKD) progression. This is most notable at the earlier stages of diabetic and proteinuric nephropathies.Objective. Here, we observed the impact of discontinuation of...

  • Clinicopathologic findings relevant to disappearance or relapse of proteinuria following corticosteroid treatment in IgA nephropathy patients with proteinuria of 0.5 to 2.0?g/day. Suzuki, Takayuki; Yamamoto, Tatsuo; Ohura, Masaharu; Fujigaki, Yoshihide; Yonemura, Katsuhiko; Kimura, Masato; Hishida, Akira // Clinical & Experimental Nephrology;Sep2004, Vol. 8 Issue 3, p243 

    Background. We investigated the clinical and pathological findings relevant to the efficacy of corticosteroid treatment in IgA nephropathy patients with 0.5 to 2.0 g/day of proteinuria at the initiation of corticosteroid treatment. Methods. In 27 IgA nephropathy patients who received 2-year...

  • Uncoupling of Glomerular IgA Deposition and Disease Progression in Alymphoplasia Mice with IgA Nephropathy. Aizawa, Masashi; Suzuki, Yusuke; Suzuki, Hitoshi; Pang, Huihua; Kihara, Masao; Nakata, Junichiro; Yamaji, Kenji; Horikoshi, Satoshi; Tomino, Yasuhiko // PLoS ONE;Apr2014, Vol. 9 Issue 4, p1 

    Previous clinical and experimental studies have indicated that cells responsible for IgA nephropathy (IgAN), at least in part, are localized in bone marrow (BM). Indeed, we have demonstrated that murine IgAN can be experimentally reconstituted by bone marrow transplantation (BMT) from IgAN prone...

  • 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...

  • Clinical validation of immunoglobulin A nephropathy diagnosis in Swedish biopsy registers. Jarrick, Simon; Lundberg, Sigrid; Welander, Adina; Fored, C. Michael; Ludvigsson, Jonas F. // Clinical Epidemiology;Jan2017, Vol. 9, p67 

    Aims: The aims of this study were to validate the diagnosis of IgA nephropathy (IgAN) in Swedish biopsy registers against patient charts and to describe the clinical characteristics of patients with a biopsy indicating IgAN. Methods: This is a population-based cohort study. Out of 4,069...

  • Precocious activation of genes of the renin-angiotensin system and the fibrogenic cascade in IgA glomerulonephritis. Del Prete, Dorella; Gambaro, Giovanni; Lupo, Antonio; Anglani, Franca; Brezzi, Brigida; Magistroni, Riccardo; Graziotto, Romina; Furci, Luciana; Modena, Francesca; Bernich, Patrizia; Albertazzi, Alberto; D'Angelo, Angela; Maschio, Giuseppe // Kidney International;Jul2003, Vol. 64 Issue 1, p149 

    Precocious activation of genes of the renin-angiotensin system and the fibrogenic cascade in IgA glomerulonephritis. Background. The renin-angiotensin system (RAS) seems to play a pivotal role in progression of immunoglobulin A (IgA) nephropathy (IgAN). Accordingly, in patients with IgAN a...

  • Prognosis in IgA Nephropathy: 30-Year Analysis of 1,012 Patients at a Single Center in Japan. Moriyama, Takahito; Tanaka, Kayu; Iwasaki, Chihiro; Oshima, Yasuko; Ochi, Ayami; Kataoka, Hiroshi; Itabashi, Mitsuyo; Takei, Takashi; Uchida, Keiko; Nitta, Kosaku // PLoS ONE;Mar2014, Vol. 9 Issue 3, p1 

    Background: Little is known about the long-term prognosis of patients with IgA nephropathy (IgAN). Methods: This retrospective cohort analysis evaluated clinical and histological findings at the time of renal biopsy, initial treatment, patient outcomes over 30 years, and risk factors associated...


Read the Article


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

Try another library?
Sign out of this library

Other Topics