Περίληψη:
Background: Natural history, predisposing factors to an unfavourable outcome and the effect of various therapeutic regimens were evaluated in a cohort of 457 patients with immunoglobulin A nephropathy (IgAN) and follow-up of at least 12 months. Methods: Patients with normal renal function and proteinuria <1 g/24 h as well as those with serum creatinine (SCr) >2.5 mg/dL and/or severe glomerulosclerosis received no treatment. Patients with normal or impaired renal function and proteinuria >1 g/24 h for >6 months received daily oral prednisolone or a 3-day course of intravenous (IV) methylprednisolone followed by oral prednisolone per os every other day or a combination of prednisolone and azathioprine. The clinical outcome was estimated using the primary endpoints of end-stage renal disease and/or doubling of baseline SCr. Results: The overall 10-year renal survival was 90.8%, while end-stage renal disease and doubling of baseline SCr developed in 9.2% and 14.7% of patients, respectively. Risk factors related to the primary endpoints were elevated baseline SCr, arterial hypertension, persistent proteinuria >0.5 g/24 h and severity of tubulointerstial fibrosis. There was no difference in the clinical outcome of patients treated by the two regimens of corticosteroids; nevertheless, remission of proteinuria was more frequent in patients who received IV methylprednisolone (P ¼ 0.000). The combination of prednisolone with azathioprine was not superior to IV methylprednisolone followed by oral prednisolone. Side effects related to immunossuppressive drugs were observed in 12.8% of patients. Conclusion: The clinical outcome of patients with IgAN was related to the severity of clinical and histological involvement. The addition of azathioprine to a corticosteroid-based regimen for IgAN does not improve renal outcome. © The Author 2017.
Συγγραφείς:
Stangou, M.
Papasotiriou, M.
Xydakis, D.
Oikonomaki, T.
Marinaki, S.
Zerbala, S.
Stylianou, C.
Kalliakmani, P.
Andrikos, A.
Papadaki, A.
Balafa, O.
Golfinopoulos, S.
Visvardis, G.
Moustakas, G.
Papachristou, E.
Kouloukourgiotou, T.
Kapsia, E.
Panagiotou, A.
Koulousios, C.
Kavlakoudis, C.
Georgopoulou, M.
Panagoutsos, S.
Vlahakos, D.V.
Apostolou, T.
Stefanidis, I.
Siamopoulos, K.
Tzanakis, I.
Papadogiannakis, A.
Daphnis, E.
Iatrou, C.
Boletis, J.N.
Papagianni, A.
Goumenos, D.S.
Λέξεις-κλειδιά:
azathioprine; creatinine; cyclophosphamide; methylprednisolone; mycophenolate mofetil; prednisolone, adult; Article; clinical outcome; cohort analysis; conservative treatment; corticosteroid therapy; creatinine blood level; disease predisposition; disease registry; disease severity; drug dose reduction; end stage renal disease; female; follow up; glomerulosclerosis; Greece; histopathology; human; human tissue; hypertension; immunoglobulin A nephropathy; immunosuppressive treatment; kidney biopsy; kidney fibrosis; kidney function; major clinical study; male; medical society; overall survival; priority journal; proteinuria; remission; retrospective study; risk factor
