Hirofumi Watanabe1, Shin Goto2, Daisuke Kondo3, Takuma Takata4, Hajime Yamazaki5, Michihiro Hosojima6, Suguru Yamamoto1, Yoshikatsu Kaneko1, Ryuji Aoyagi7, Ichiei Narita1. 1. Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuoku, Niigata, Niigata, 951-8510, Japan. 2. Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuoku, Niigata, Niigata, 951-8510, Japan. gotos@med.niigata-u.ac.jp. 3. Department of Nephrology and Rheumatology, Niigata City General Hospital, Niigata, Japan. 4. Department of Nephrology, Nagaoka Chuo General Hospital, Nagaoka, Japan. 5. Department of Internal Medicine, Nagaoka Red Cross Hospital, Nagaoka, Japan. 6. Department of Clinical Nutrition Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan. 7. Department of Nephrology, Tachikawa General Hospital, Nagaoka, Japan.
Abstract
BACKGROUND: IgA nephropathy (IgAN) is a chronic glomerular disease that causes end-stage renal disease in 20-40 % of patients within 20 years. The efficacy of tonsillectomy combined with steroid pulse (SP) administration (TSP) for clinical remission of IgAN has been reported. Particularly in Japan, TSP has been performed widely. However, the optimum method for steroid administration in TSP has not been established. METHODS: We retrospectively compared clinical remission in IgAN patients treated with tonsillectomy combined with two different steroid administration methods: (1) three courses of SP therapy and oral prednisolone administered on alternate days (group 3A; n = 25); and (2) one course of SP therapy and oral prednisolone administered on consecutive days (group 1C; n = 22). RESULTS: There was no significant difference in the clinical remission rates between the two groups at 12 (48.0 vs. 40.9 %, P = 0.77) and 24 months after starting treatment (68.0 vs. 72.7 %, P = 0.76) and at the final observation (76.0 vs. 81.8 %, P = 0.73). The mean period from starting treatment to remission of hematuria in group 3A was significantly shorter than that in group 1C (5.7 ± 4.4 vs. 9.9 ± 5.9 months, P = 0.03). Dyslipidemic patients treated for the first time with statin after the SP therapy were more present in group 3A at 24 months (P = 0.02). CONCLUSIONS: In IgAN patients, treatment of group 3A may be effective for inducing rapid remission of hematuria. Further studies are needed to establish an appropriate protocol for TSP.
BACKGROUND:IgA nephropathy (IgAN) is a chronic glomerular disease that causes end-stage renal disease in 20-40 % of patients within 20 years. The efficacy of tonsillectomy combined with steroid pulse (SP) administration (TSP) for clinical remission of IgAN has been reported. Particularly in Japan, TSP has been performed widely. However, the optimum method for steroid administration in TSP has not been established. METHODS: We retrospectively compared clinical remission in IgANpatients treated with tonsillectomy combined with two different steroid administration methods: (1) three courses of SP therapy and oral prednisolone administered on alternate days (group 3A; n = 25); and (2) one course of SP therapy and oral prednisolone administered on consecutive days (group 1C; n = 22). RESULTS: There was no significant difference in the clinical remission rates between the two groups at 12 (48.0 vs. 40.9 %, P = 0.77) and 24 months after starting treatment (68.0 vs. 72.7 %, P = 0.76) and at the final observation (76.0 vs. 81.8 %, P = 0.73). The mean period from starting treatment to remission of hematuria in group 3A was significantly shorter than that in group 1C (5.7 ± 4.4 vs. 9.9 ± 5.9 months, P = 0.03). Dyslipidemic patients treated for the first time with statin after the SP therapy were more present in group 3A at 24 months (P = 0.02). CONCLUSIONS: In IgANpatients, treatment of group 3A may be effective for inducing rapid remission of hematuria. Further studies are needed to establish an appropriate protocol for TSP.
Entities:
Keywords:
IgA nephropathy; Steroid pulse therapy; Tonsillectomy; Treatment protocol
Authors: Juan Antonio Moreno; Claudia Yuste; Eduardo Gutiérrez; Ángel M Sevillano; Alfonso Rubio-Navarro; Juan Manuel Amaro-Villalobos; Manuel Praga; Jesús Egido Journal: Pediatr Nephrol Date: 2015-05-17 Impact factor: 3.714
Authors: Daniel C Cattran; Rosanna Coppo; H Terence Cook; John Feehally; Ian S D Roberts; Stéphan Troyanov; Charles E Alpers; Alessandro Amore; Jonathan Barratt; Francois Berthoux; Stephen Bonsib; Jan A Bruijn; Vivette D'Agati; Giuseppe D'Amico; Steven Emancipator; Francesco Emma; Franco Ferrario; Fernando C Fervenza; Sandrine Florquin; Agnes Fogo; Colin C Geddes; Hermann-Josef Groene; Mark Haas; Andrew M Herzenberg; Prue A Hill; Ronald J Hogg; Stephen I Hsu; J Charles Jennette; Kensuke Joh; Bruce A Julian; Tetsuya Kawamura; Fernand M Lai; Chi Bon Leung; Lei-Shi Li; Philip K T Li; Zhi-Hong Liu; Bruce Mackinnon; Sergio Mezzano; F Paolo Schena; Yasuhiko Tomino; Patrick D Walker; Haiyan Wang; Jan J Weening; Nori Yoshikawa; Hong Zhang Journal: Kidney Int Date: 2009-07-01 Impact factor: 10.612
Authors: Claudio Pozzi; Simeone Andrulli; Lucia Del Vecchio; Patrizia Melis; Giovanni B Fogazzi; Paolo Altieri; Claudio Ponticelli; Francesco Locatelli Journal: J Am Soc Nephrol Date: 2004-01 Impact factor: 10.121
Authors: Daniel P Gale; Karen Molyneux; David Wimbury; Patricia Higgins; Adam P Levine; Ben Caplin; Anna Ferlin; Peiran Yin; Christopher P Nelson; Horia Stanescu; Nilesh J Samani; Robert Kleta; Xueqing Yu; Jonathan Barratt Journal: J Am Soc Nephrol Date: 2017-02-16 Impact factor: 10.121