Recovery of renal function after glucocorticoid therapy for IgG4-related kidney disease with renal dysfunction.

Saeki, Takako; Kawano, Mitsuhiro; Mizushima, Ichiro; Yamamoto, Motohisa; Wada, Yoko; Ubara, Yoshifumi; Nakashima, Hitoshi; Ito, Tomoyuki; Yamazaki, Hajime; Narita, Ichiei; Saito, Takao

Background: Although renal dysfunction in IgG4-related kidney disease (IgG4-RKD) shows rapid resolution with glucocorticoid therapy, little is known about the appropriate initial glucocorticoid dose for induction therapy or long-term renal outcome. Methods: We retrospectively examined the differences in recovery of renal function according to the dose of glucocorticoid used for induction therapy and the long-term renal outcome in 43 patients with definite IgG4-RKD (mostly IgG4-tubulointerstitial nephritis), in whom the estimated glomerular filtration rate (eGFR) before glucocorticoid therapy was <60 ml/min. Results: Most patients were treated with glucocorticoid alone and had been maintained on glucocorticoid. The initial dose of prednisolone employed was ≤0.6 mg/kg/day (mean 0.47) in 27 patients (group L), and >0.6 mg/kg/day (mean 0.81) in 16 patients (group H). In both groups, the pretreatment eGFR was significantly improved at 1 month after the start of glucocorticoid therapy and the degree of improvement showed no significant inter-group difference. Relapse of IgG4-RKD occurred in 16.7 % of the group L patients and 13.3 % of the group H patients ( p = 0.78). Among 29 patients who were followed up for over 36 months (mean 74 months) and had been maintained on glucocorticoid, none showed progression to end-stage renal disease and there was no significant difference between eGFR at 1 month after treatment and eGFR at the last review. Conclusion: In glucocorticoid monotherapy for IgG4-RKD, a moderate dose is sufficient for induction, and recovery of renal function can be maintained for a long period on low-dose maintenance, although relapse can occur even in patients receiving maintenance therapy.

GLUCOCORTICOIDS; IMMUNOGLOBULIN G; KIDNEY disease treatments; HEALTH outcome assessment; TUBULOINTERSTITIAL nephritis & uveitis syndrome

Clinical & Experimental Nephrology, 2016, Vol 20, Issue 1, p87

1342-1751

Academic Journal

10.1007/s10157-015-1140-0