Steroid and cyclophosphamide in IgA nephropathy

Background. IgA nephropathy is associated with a wide spectrum of possible lesions. Therefore, different responses to anti-inflammatory or immunosuppr essive therapies should be expected with acute inflammatory changes, which are predominantly reversible, and with prevalently sclerotic lesions. Methods. The effects of a combined schedule of prednisone and cyclophospham ide was analysed in the specific subset of IgA nephropathy patients with ac ute inflammatory histologic changes associated with haematuria and proteinu ria. Two groups of patients, with similar histologic lesions and clinical p resentation, were considered. The first group (12 patients) was treated wit hin 1 week after renal biopsy; starting with three pulses of methylpredniso lone (Ig) followed by oral prednisone (0.8 mg/kg body weight for 2 weeks, 0 .6 mg/kg for another 2 weeks, 0.4 mg/kg for an additional 4 weeks, then slo wly tapered by 5 mg each month until discontinuation) and 1.5 mg/kg cycloph osphamide for 2 months. A second sample of eight untreated patients served as a control group. Treated and untreated patients had diffuse mesangial pr oliferation with florid crescents (8-60% in treated and 10-40% in untreated patients) with mild degree of glomerular sclerosis and interstitial change s. Basal creatinine (167 mu mol/l, range 79-371 vs 132 mu mol/l, range 79-2 56) and proteinuria (3.0 g/24 h, 1.0-4.9 vs 3.3 g/24 h, 1.0-13.7) were not statistically different between treated and untreated patients respectively . Nine treated and six untreated patients were hypertensive. Blood pressure treatment did not include ACE-inhibitors. Results. Untreated patients' 5-year renal survival, as assessed by the Kapl an-Meier method, was found to be significantly lower than treated patients (37.5 vs 91.6%, log-rank P=0.01 and Breslow test P=0.008; relative risk to reach the endpoint of a 100% increase in serum creatinine = 3.58, P=0.03). Conclusion. This short course of therapy with prednisone and cyclophosphami de has been effective in a subset of IgA nephropathy patients with florid g lomerular changes and major urinary abnormalities, turning off phlogistic a ctivity and preventing subsequent progression toward renal failure.