Combination therapy using prednisolone and cyclophosphamide slows the progression of moderately advanced IgA nephropathy

Aim:We retrospectively examined the effect of combination therapy using pre dnisolone (PSL) and cyclophosphamide (CPA) on the progression of IgA nephro pathy (IgAN) in 45 patients with moderate to severe histological changes. P atients and methods: Patients were recruited from 129 consecutive patients with IgAN seen over 10 years based on semiquantitative histological grading . They were divided into two groups: PSL+CPA. group (n = 26, male/female = 11/15, age 40 +/- 3 years (SEM)) or control group undergone conventional th erapy with or without antiplatelet agents (n = 19, male/female = 10/9, age 41 +/- 3). In PSL+CPA group, PSL and CPA treatment commenced using a dose o f 30 and 50 mg/day, respectively. PSL was reduced by 5 mg every month. Resu lts: The clinical parameters at the start of treatment such as age, gender, histological score, blood pressure, urinary protein excretion and serum cr eatinine concentration (SCr) were not different between the groups. The mea n observation period in PSL+CPA group (3.3 +/- 0.3 years) was not different from the control group (4.0 +/- 0.7 years). In PSL+CPA group, urinary prot ein excretion, defined as the ratio of urinary protein to creatinine concen tration (UP/UCr), significantly decreased from 3.9 +/- 0.4 to 1.3 +/- 0.2 ( p < 0.01), whereas it remained high in the control group (3.8 +/- 0.7 to 2. 7 +/- 0.8). The progression rate (PR), which was determined by the slope of the correlation between time after renal biopsy and reciprocal SCr, was si gnificantly lower in PSL+CPA (0.054 +/- 0.014) than in the control group (0 .172 +/- 0.032 dl/mg/year, p < 0.001). Our results indicated that PSL+CPA c ombination therapy was effective in slowing the progression of moderately a dvanced IgAN. Conclusion: We suggest that the immunosuppressive treatment w ith CPA is sometimes necessary to preserve renal function in patients with histologically advanced IgAN.