Effect of corticosteroid and cyclophosphamide in IgA nephropathy patients with heavy proteinuria and/or moderate-severe pathological changes.

BACKGROUND: The treatment of immunoglobulin (Ig) A nephropathy remains a subject of controversy. To clarify if it is justified to use corticosteroid and cyclophosphamide in the treatment of IgA nephropathy patients with heavy proteinuria and/or a moderate-severe pathological grading of at least grade II, we retrospectively analyzed the medical data of IgA nephropathy patients in our hospital.

METHODS: Totally 60 patients from 370 cases of biopsy-proved IgA nephropathy in our hospital between 1983 and 1999 met the selection criteria and were enrolled into this analysis. These patients received either corticosteroid alone or in combination with cyclophosphamide. The analysis of the progression of renal disease by serum creatinine and changes in the level of proteinuria were based on an on-treatment approach. Kidney survival curve was by Kaplan-Meier analysis and compared among different subgroups.

RESULTS: Of the 60 patients, 20 cases (33.3%) (Group 1) reached a complete remission of proteinuria by prednisolone alone. The other cases received a combination therapy with corticosteroid and cyclophosphamide, which resulted in complete remission in 17 cases (28.3%) (Group 2), partial remission in 9 cases (15.0%) (Group 3) and complete resistance in 14 patients (23.3%) (Group 4). The renal survival rate was significantly worse in Group 4 (p < 0.05) as compared with other groups.

CONCLUSIONS: We conclude that corticosteroid and combination therapy with corticosteroid and cyclophosphamide was effective treatment in 61.6% (Groups 1 and 2) of IgA nephropathy patients with heavy proteinuria and/or moderate-severe pathological lesions provided their initial serum creatinine level was < or = 3 mg/dl.