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Abstract: TH-PO1038

Steroid Responsiveness on Remission of Urinary Abnormalities According to the Pathological Lesions in IgA nephropathy: A Japanese Multicenter Prospective Cohort Study

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Katafuchi, Ritsuko, National Fukuoka-Higashi Medical Center, Koga, Fukuoka, Japan
  • Kawamura, Tetsuya, Jikei University School of Medicine, Tokyo, Japan
  • Hashiguchi, Akinori, Keio University School of Medicine, Tokyo, Japan
  • Hisano, Satoshi, University of Occupational and Environment Health, Kitakyushu, Japan
  • Shimizu, Akira, Nippion Medical School, Tokyo, Japan
  • Joh, Kensuke, Tohoku University Graduate School of Medicine, Sendai-city, Japan

Group or Team Name

  • The IgA nephropathy Study Group in Japan
Background

The effectiveness of steroids on clinical course and its indication in IgA nephropathy (IgAN) are controversial.

Methods

797 patients with IgAN were included. Treatment groups were defined by steroid (ST) and tonsillectomy (TX): group 1; ST-TX-, groups 2; TX only, group 3; ST only, group 4; TX+ST+. Acute lesions (AL) such as cellular or fibrocellular crescent, or tuft necrosis, chronic lesions (CL) such as fibrous crescent, segmental or global glomerulosclerosis, Japanese histological grade (HG) and Oxford classification (MEST-C) were evaluated. The endpoint was the remission of urinary abnormality within 24 months. The remission of proteinuria (UPR) was defined less than 0.3/day. The remission of hematuria (OBR) was defined less than 5 RBC/HPF. Clinical remission (CLR) was defined UPR and OBR. The effect of treatment groups, and pathological parameters on UPR, OBR, and CLR was analyzed by logistic model.

Results

The mean age was 38, the median of UP was 0.58, mean eGFR was 76.9. The median AL, CL was 3.8, and 20%. AL and CL were tertile categorized with 0 and 7.7 % for AL and 13.3 and 30.8% for CL as cutting values. HG1 to 4 was 61, 26, 10, and 2.8 %. M1, E1, S1, T1-2 and C1-2 were 24, 36, 81, 27, 62 %. The treatment group 1 to 4 was 35, 5, 25 and 40 %. Group 3 and 4 showed significant positive effect on UPR, OBR and CLR with reference (ref) group 1. The effect of group 4 with ref group 3 was significant on OBR. AL3 showed significant positive effect with ref AL1 on UPR and CLR. CL2 and CL3 showed significant negative effect with ref CL1 on UPR. CL3 showed significant negative effect on CLR. HG2 and HG3-4 showed significant negative effect on UPR with ref HG1. HG3-4 showed significant negative effect on CLR. E1 showed significant positive effect on UPR. M1, S1, T1-2 showed significant negative effect on UPR with ref M0, S0, and T0. On CLR, C1-2 showed significant positive effect with ref C0, and T12 showed significant negative effect with ref T0.

Conclusion

Steroid was significantly effective on proteinuria and hematuria. Higher percentage of acute lesions showed significant effect of steroid on proteinuria. The additional effect of tonsillectomy to steroid was found on hematuria.

Funding

  • Government Support - Non-U.S.