Disappearance of glomerular IgA deposits in childhood IgA nephropathy showing diffuse mesangial proliferation after 2 years of combination/prednisolone therapy.

Abstract

BACKGROUND:

The prognosis of children with severe IgA nephropathy showing diffuse mesangial proliferation is poor. However, the prognosis can be improved by combination therapy (prednisolone + azathioprine or mizoribine + warfarin + dipyridamole) or prednisolone alone over a 2-year period, and disappearance of glomerular IgA deposits is often observed. Details of the incidence and clinicopathological significance of glomerular IgA disappearance remain unclear.

METHODS:

To investigate this phenomenon, we retrospectively screened and analysed 124 consecutive children (age ≤ 18 years at first biopsy) with newly diagnosed severe IgA nephropathy showing diffuse mesangial proliferation, who received combination therapy or prednisolone alone for 2 years and underwent repeat biopsies.

RESULTS:

Among these patients, 90 received combination therapy, and 34 received prednisolone alone. After 2 years of treatment, 27 of the patients (21.8%) showed disappearance of glomerular IgA. Logistic analysis showed that IgA disappearance was associated with less severe urinary protein excretion at the end of treatment. Kaplan-Meier analysis of the long-term course revealed a significant difference in proteinuria-free survival after the 2-year treatment period between the patients with IgA disappearance and those without (P = 0.008; log-rank test). The Cox proportional hazards model showed that disappearance of glomerular IgA after the treatment was a factor significantly associated with proteinuria-free survival in both univariate and multivariate analyses.

CONCLUSIONS:

The present results suggest that disappearance of IgA after 2 years of treatment indicates milder disease severity, even in patients with diffuse mesangial proliferation, and is a prognostic factor related to proteinuria-free survival.

• Authors: Yuko Shima, Koichi Nakanishi, Koichi Kamei, Hiroko Togawa, Kandai Nozu, Ryojiro Tanaka, Satoshi Sasaki, Kazumoto Iijima, Norishige Yoshikawa
• Journal: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association (Nephrol Dial Transplant) Vol. 26 Issue 1 Pg. 163-9 (Jan 2011) ISSN: 1460-2385 [Electronic] England
• PMID: 20601366 (Publication Type: Journal Article)

Chemical References

• Anti-Inflammatory Agents
• Anticoagulants
• Immunoglobulin A
• Immunosuppressive Agents
• Ribonucleosides
• Vasodilator Agents
• mizoribine
• Warfarin
• Dipyridamole
• Prednisolone
• Azathioprine

Topics

• Anti-Inflammatory Agents (therapeutic use)
• Anticoagulants (therapeutic use)
• Azathioprine (therapeutic use)
• Child
• Dipyridamole (therapeutic use)
• Drug Therapy, Combination
• Female
• Glomerular Mesangium (drug effects, immunology)
• Glomerulonephritis, IGA (drug therapy, immunology, pathology)
• Humans
• Immunoglobulin A (immunology)
• Immunosuppressive Agents (therapeutic use)
• Kidney Glomerulus (drug effects, metabolism, pathology)
• Male
• Prednisolone (therapeutic use)
• Retrospective Studies
• Ribonucleosides (therapeutic use)
• Survival Rate
• Treatment Outcome
• Vasodilator Agents (therapeutic use)
• Warfarin (therapeutic use)