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Kidney Week

Abstract: SA-PO899

Long-Term Follow-Up of Methylprednisolone (MP) Pulse and Mesenchymal Stem Cell (MSC) Therapy in Severe IgA Nephropathy

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Cho, Byoung-Soo, Dr. Cho's Kidney Clinic, Seoul, Korea (the Republic of)
  • Cho, Won-Hee, Sahmyook General Hospital, Seoul, Korea (the Republic of)
Background

Up to date there is no specific treatment method for severe IgA nephropathy, but giving ARB,MRA,omega-3,antiplatelet therapy, complement inhibitors,Nefecon,endothelin inhibitors,SGLT2 inhibitor etc. and eventually fall into ESRD and need dialysis or KTP.
Cell based therapy especially autologous adipose derived stromal vascular fraction (SVF)/mesenchymal stem cells (MSC) is an emerging field in intractable immune-mediated disorders such as GVHD, multiple sclerosis, Crohn's disease, osteoarthritis and even immune dysregulating infectious diseases, however reports in nephrology field are very rare. We firstly reported 2 years follow up results of MP pulse and MSC in severe IgAN in 2015 (ASN) with promising results.
We tried MP pulse therapy followed by autologous MSC and follow up for 7 to 9 years in severe IgA nephropathy.

Methods

We selected severe IgA nephropathy as two groups ,first group by clinical CKD stage 3b or more (A) and second group by pathologically severe group as Lee's classification grade IV or V (B), and tried methylprednisolone pulse therapy followed by SVF/MSC. One cycle of methyl PD pulse is (20-30mg/kg/day,max 1g/day) for 3 consecutive days. We tried 3 to 17 cycles depends on the renal pathology, followed by autologous adipose derived SVF/MSC intravenously. Mean cell count was 3x10(7)/injection. Depends on the amount of harvested fat we tried 2-4 times.

Results

Seven patients were group A. Mean age 60 years old. Mean initial eGFR before therapy was 28 ml/min and after therapy 39 ml/min. Mean follow up period was 6.8 years. Control patient (eGFR 33 ml/min) without treatment started hemodialysis in 2 years. Three patients were group B. Mean age 25 years old. Mean initial eGFR before therapy was 85 ml/min and after therapy 106 ml/min. Mean follow up period was 9.3 years. No significan side-effects were noted. Follow up renal biopsy showed disapperance of mesangisl deposits, reduced mesangial proliferation, improved epthelial foot process fusion and disappearance of IgA depositon by immunofluorecent microscopy.

Conclusion

Follow up renal biopsy after MP pulse and SVF/MSC showed disappearance of immune deposits and improved subepthelial foot process fusion.
Longterm follow up of MP-pulse and MSC/SVF therapy in severe IgA nephropathy showed a promising results and could be a lifesaving therapeutic strategies, although further studies are mandatory