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- Title
Mid-term effects of steroid therapy on childhood-onset IgA nephropathy.
- Authors
Watanabe, S; Hattori, M; Akioka, Y; Yamaguchi, Y; Ito, K
- Abstract
Purpose: IgA nephropathy (IgAN) is considered the most common glomerular disease in the world. Although treatment of children with severe IgAN with predonisolone (PSL) has been reported, the mid-term prognosis of paediatric patients treated with PSL is unclear. In the present study we examined the mid-term effects of PSL therapy. Method: Thirty-seven paediatric patients with IgAN (18 males, 19 females), whose biopsy findings showed acute segmental lesions including cellular crescent and adhesion in more than 10% of glomeruli examined, were prospectively treated with PSL plus heparin-warfarin and dipyridamole (Tx) for 1.5 years and followed up over 1 years after Tx end. Fifteen age and histological grade-matched children with IgAN (six males, nine females), who had never been treated with PSL, were also evaluated as a historical control. The mean observation period was 5.0 ± 1.8 years (range, 2.5–8.6 years). The histological grade (acute lesion) and stage (chronic lesion) were scored semiquantitatively based on the Shigematsu’s grade-stage system.1 Result: Proteinuria decreased 1.48 g/day/1.73 m2 at the start of Tx to 0.32 g/day/1.73 m2 at the end of Tx. Eighteen patients (48.6%) achieved complete remission (CR). No patient developed chronic renal failure in Tx group, while two of the controls deteriorated renal function in the last observation. The pattern of responsiveness to Tx were divided into three groups according to the levels of proteinuria: CR, rebound (> 0.5 g/day/1.73 m2) and incomplete remission (< 0.5 g/day/1.73 m2). The rebound of proteinuria is usually accompanied with PSL reduction. The grade of glomerular pathology was improved with Tx (Gg: 0.8–0.3), while the stage of tubulo-interstitial change progressed (Sint: 0.7–1.2). Conclusions: The present study shows that Tx to children with IgAN showing acute lesions for 1.5 years is effective to subside acute glomerular injury. However, because clinical courses of treated patients vary in each patient, dosage and duration of PSL administration should be modified in their clinical setting.
- Subjects
STEROID drugs; PEDIATRIC nephrology
- Publication
Nephrology, 2001, Vol 6, pA17
- ISSN
1320-5358
- Publication type
Article
- DOI
10.1046/j.1440-1797.2001.00013.x