A controlled trial of combined therapy for newly diagnosed severe childhood IgA nephropathy

The most appropriate treatment for patients with IgA nephropathy is controv ersial, Treatment with prednisolone, azathioprine, heparin-warfarin, and di pyridamole early in the course of disease may prevent immunologic renal inj ury in children with severe IgA nephropathy. To determine whether similar r esults can be obtained with a combination of just heparin-warfarin and dipy ridamole, the effects of such treatment were compared to those of treatment with prednisolone, azathioprine, heparin-warfarin, and dipyridamole in 78 children with newly diagnosed IEA nephropathy showing diffuse mesangial pro liferation. The patients were randomly assigned to receive either prednisol one, azathioprine, heparin-warfarin, and dipyridamole for 2 yr (group 1) or heparin-warfarin and dipyridamole for 2 yr (group 2). ALI of the 40 patien ts in group 1 and 34 of the 38 patients in group 2 completed the trial. The mean urinary protein excretion fell in group 1 patients (P < 0.0001), but remained unchanged in group 2 patients. The mean serum IgA concentration wa s reduced in group 1 patients (P = 0.0002), but was unchanged in group 2 pa tients. BP and creatinine clearance were normal at the end of the trial in all but one group 2 patient, who developed chronic renal insufficiency. The percentage of glomeruli showing sclerosis was unchanged in group I patient s, but increased in group 2 patients (P = 0.006). The intensity of mesangia l IgA deposits decreased in group 1 patients (P = 0.02), but remained uncha nged in soup 2 patients. In conclusion, the present study shows that treatm ent of children with severe IgA nephropathy with prednisolone, azathioprine , heparin-warfarin, and dipyridamole for 2 yr early in the course of diseas e reduces immunologic renal injury and prevents increase of sclerosed glome ruli.