STEROID-THERAPY IN PROGRESSIVE IGA NEPHROPATHY - A 10-YEAR FOLLOW-UP-STUDY

This study was undertaken in order to evaluate the effect of steroid t herapy on the long-term clinical course in progressive IgA nephropathy with persistent massive proteinuria of greater than or equal to 1.0 g /day. From 1972 to 1986, 109 patients with persistent massive proteinu ria who were continuously followed up during a 10 year period. Seventy -seven of these patients had moderate proteinuria of 1-2 g/day and the remaining 32 patients had heavy proteinuria of more than 2 g/day. The 109 patients were divided into three groups according to the grade of renal function and histological severity: group 1 (58 cases), preserv ed renal function (creatinine clearance rate [Ccr] greater than or equ al to 70 mL/min) and moderate to severe histology (total score greater than or equal to 7); group 2 (35 cases), decreased renal function (Cc r < 70 mL/min) and moderate to severe histology; and group 3 (16 cases ), preserved renal function and mild histology (total score less than or equal to 6). Fifty-five patients received steroid therapy for 2 yea rs, followed by an anti-platelet drug therapy until the completion of the study. Fifty-four patients were treated with only an anti-platelet drug therapy for the duration of the study. There were no significant differences in renal function and renal survival rates over the 10 ye ar period between the steroid-treated and the non-steroid-treated grou ps. Among the moderately proteinuric patients of group 1, the 20 stero id-treated patients showed significantly favourable clinical courses c ompared to the 26 non-steroid-treated patients of the same group. The 12 heavily proteinuric, steroid-treated patients of the group 1 also s howed significantly favourable courses compared to those 26 moderately proteinuric, non-steroid patients. However, all but one patient in gr oup 2, (with and without steroid therapy) went into end-stage renal fa ilure within the 10 year follow-up period. These results indicate that corticosteroid treatment has a long-term beneficial effect for the st abilization of renal function in progressive IgA nephropathy with mass ive proteinuria greater than or equal to 1.0 g/day, when patients have preserved renal function of 70 m L/min or more in initial Ccr values.