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NDT Advance Access originally published online on July 20, 2008
Nephrology Dialysis Transplantation 2008 23(12):3915-3920; doi:10.1093/ndt/gfn394
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© The Author [2008].
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org


The improvement of renal survival with steroid pulse therapy in IgA nephropathy

Ritsuko Katafuchi1, Toshiharu Ninomiya2, Tohru Mizumasa1, Kiyoshi Ikeda1, Harumitsu Kumagai1, Masaharu Nagata2 and Hideki Hirakata1

1 The Kidney Unit, Fukuoka Red Cross Hospital 2 The Department of Medicine and Clinical Science, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan

Correspondence and offprint requests to: Ritsuko Katafuchi, National Fukuoka-Higashi Medical Center, 1-1-1, Chidori, Koga city, Fukuoka, 811-3195, Japan. Tel: +81-92-943-2331; Fax: +81-92-943-8775; E-mail: katafuchir{at}fukuokae2.hosp.go.jp



  Abstract

Background. The benefits of steroid therapy in immunoglobulin A nephropathy (IgAN) have not been established.

Methods. The effect of steroids on kidney survival was retrospectively investigated in 702 patients with IgAN by multivariate analyses.

Results. There were 295 men and 407 women. The median follow-up period was 62 months. One hundred and ninety-four patients were treated with oral steroids (oral steroid group). Thirty-four patients were treated with methylprednisolone (mPSL) pulse therapy (pulse steroid group) followed by oral prednisolone (PSL). In 474 patients, no steroid was used (no steroid group). The urinary protein-creatinine ratio and histological grade were significantly different among treatment groups and were highest in the pulse steroid group followed by the oral steroid group and lowest in the no steroid patients. Serum creatinine was significantly higher in the pulse steroid group than in other two groups. Eighty-five patients developed end-stage renal failure (ESRF) requiring haemodialysis. In multivariate analysis, steroid pulse therapy significantly decreased the risk of ESRF while oral steroid treatment did not improve renal survival in this cohort.

Conclusion. We found that pulse steroid therapy improved kidney survivals in IgAN. Since the clinical findings and histological grade were the most severe in patients treated with mPSL pulse therapy, such therapy may prevent progression of IgAN.

Keywords: histological grade; IgA nephropathy; multivariate analysis; steroid pulse therapy; the Cox proportional hazards model

Received for publication: 9. 9.07
Accepted in revised form: 20. 6.08


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