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Abstract: TH-PO1025

Analysis of Appropriate Treatment for IgA Nephropathy with Mild Proteinuria

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Ogura, Shota, Tokyo Women's Medical University, Tokyo, Japan
  • Moriyama, Takahito, Tokyo Women's Medical University, Tokyo, Japan
  • Karasawa, Kazunori, Tokyo Women's Medical University, Tokyo, Japan
  • Nitta, Kosaku, Tokyo Women's Medical University, Tokyo, Japan
Background

The 2012 KDIGO clinical practice guidelines recommended the renin angiotensin system inhibitors (RASIs) for the IgA nephropathy (IgAN) patients with mild proteinuria (0.5 to 1 g/day) as treatment. However, in Japan, tonsillectomy and steroid pulse therapy (TSP) was frequently employed in a lot of institutions, even though corticosteroid therapy was recommended only for the patients with persistent proteinuria over 1 g/day, despite of 3-6 months of supportive care, and tonsillectomy was not recommended. Then, we analyzed the appropriate treatment for the IgAN patients with mild proteinuria.

Methods

In this retrospective cohort analysis, 127 patients diagnosed as IgAN by renal biopsy from 1980 to 2015 in our institution, and had mild proteinuria (0.5 – 1.0 g/day) and eGFR ≧60 ml/min/1.73m2 were analyzed. We divided them into three groups: patients treated with TSP (TSP, n=34), with oral prednisolone (oPSL, n=33), and with conservative therapy (CON, n=50). We analyzed the clinical and histological backgrounds at renal biopsy, remission rates of proteinuria (U-P) which met < 0.3 g/g creatinine(Cr), urinary red blood cell (U-RBC) < 5/high power field (HPF), and both of them (clinical remission: CR) for 5 years, and 10- years renal survival rate among three groups.

Results

The clinical and histological backgrounds were similar among three groups (median U-P was around 0.70 g/gCr (p=0.28), median eGFR was around 80.0 ml/min/1.73m2 (p=0.14) and median U-RBC were around 20/HPF in each group (p=0.48)). The remission rate of U-RBC was significantly higher in TSP (94.2%) than oPSL (60.4%, p=0.03) and CON (40.5%, p<0.0001), and also higher in oPSL than CON (p=0.02). The remission rate of U-P was significantly higher in TSP (83.1%) than in CON (30.6%, p<0.0001), and higher in oPSL (66.4%) than CON (p=0.0007), but similar between TSP and oPSL (p=0.36). The results of CR were similar with the results of U-P (TSP=oPSL>CON). There was no patient progressed to end-stage renal disease in each group. In multivariate Cox regression analysis, TSP and oPSL were independent factors for the remission of urinary findings, but TSP was not superior to oPSL.

Conclusion

In the treatment for IgAN with mild proteinuria, TSP was superior to oPSL in remission of U-RBC, and TSP and oPSL were superior to CON in the remission of urinary findings, but not for the 10-years renal prognosis.