The effects of cytotoxic therapy in progressive IgA nephropathy.

Journal Article (Journal Article)

BACKGROUND: IgA nephropathy (IgAN) is not always benign, and some patients at high risk of end-stage renal disease (ESRD) experience a rapid decline in renal function. This study retrospectively examined the beneficial effects of cytotoxic therapy. METHODS: We identified 102 patients with progressive IgAN despite optimal conservative management. Of these, 31 who received cytotoxic therapy and 55 who were managed conservatively were included. RESULTS: Median eGFR and urinary protein-to-creatinine ratio (uPCR) at baseline did not differ between the groups (p = 0.475 and 0.259, respectively). Median GFR slope was also similar (p = 0.896). Cumulative renal survival was better in the cytotoxic therapy group than in the control group (p = 0.009). Cytotoxic therapy was associated with lower risk of progression to ESRD, independent of eGFR, uPCR, GFR slope and kidney histologic findings (HR 0.13, 95% CI 0.03-0.66). In the cytotoxic therapy group, the median GFR slope decreased from -7.8 (-10.5, -5.0) mL/min/1.73 m(2) per year to -3.4 (-5.1, -1.8) mL/min/1.73 m(2) per year after treatment (p < 0.001). Mortality was not observed, but infection requiring hospitalization occurred at similar rates in both groups (p = 0.886). CONCLUSIONS: Cytotoxic therapy attenuated the rate of GFR decline and was associated with a favorable renal outcome in patients with progressive IgAN.

Full Text

Duke Authors

Cited Authors

  • Shin, J-H; Lee, JE; Park, JH; Lim, S; Jang, HR; Kwon, GY; Huh, W; Jung, S-H; Kim, Y-G; Oh, HY; Kim, DJ

Published Date

  • 2016

Published In

Volume / Issue

  • 48 / 3

Start / End Page

  • 171 - 181

PubMed ID

  • 27031662

Electronic International Standard Serial Number (EISSN)

  • 1365-2060

Digital Object Identifier (DOI)

  • 10.3109/07853890.2016.1153805

Language

  • eng

Conference Location

  • England