Treatment of vasculitic IgA nephropathy

Bacground: Patients with IgA nephropathy and histological vasculitic/cresce ntic lesions have a poor prognosis. We performed a retrospective study to a ssess whether treatment with steroids and immunosuppressants would preserve renal function by healing these lesions and thereby prevent progression to glomerular sclerosis and renal failure. Methods: Sixteen patients with IgA nephropathy and a vasculitic/crescentic glomerulonephritis diagnosed by renal histology were treated with a reducin g course of prednisolone (initial dose 60mg/day). Six patients also receive d cyclophosphamide (2mg/kg/day) for three months followed by azathioprine ( 100mg/day) in five patients. Ten patients received azathioprine (100mg/day) in addition to prednisolone. The median duration of treatment was 12 month s (range 5-30 months). At the end of treatment each patient had a second re nal biopsy. Results: Following treatment there was a significant reduction in the propo rtion of glomeruli with acute vasculitic lesions from a median of 17.4% (ra nge 4.8-57.5%) to 0 (range 0-15.8%) (p=0.001). There was an increase in the proportion of globally sclerosed glomeruli from a median of 13.4% (range 0 -44.4%) to 21.5% (range 0-90%) after treatment but this did not significant ly differ from baseline (p=0.24). The proportion of renal cortex with chron ic tubular atrophy increased from 2.55% (0.4-57.7%) to 11.3% (0,3-61%) (p=0 .09). The median duration of follow-up was 30 months (inter-quartile range 6-30 months). At both 12 and 24 months there was no significant increase in serum creatinine. Four patients, however, developed end-stage renal failur e between 24 and 81 months. Conclusion: In this retrospective study we show that treatment with steroid s and immunosuppressants leads to healing of vasculitic lesions and may thu s arrest progression of glomerular scarring.