Document Detail


Prognostic relevance of clinical and histological features in IgA nephropathy treated with steroid and angiotensin receptor blockers.
MedLine Citation:
PMID:  19863877     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The prognostic relevance of clinical and histological features on renal outcome has not been assessed in patients with IgA nephropathy (IgAN) treated with the combination therapy of steroid and angiotensin receptor blockers (ARB). METHODS: A prospective trial of a combination of steroid and ARB was performed in 50 patients with IgAN, proteinuria and serum creatinine levels < 2 mg/dl. RESULTS: Over a mean follow-up period of 4 years, the combination therapy reduced proteinuria and hematuria and improved renal function in most patients. The mean change in estimated GFR (eGFR) was + 0.30 +/- 0.74 ml/min/1.73 m2/month. Forty-three patients (86%) exhibited stable renal function and 7 patients (14%) reached the primary end point of a (3) 20% decrease in eGFR from baseline levels. Between the nonprogressive and progressive patients, there were significant differences in the levels of urine protein/ creatinine excretion ratio (PCR) at baseline and throughout the follow-up period as well as baseline eGFR and degree of glomerular crescents (p < 0.05). Forty (80%) and 24 patients (48%) had a urine PCR < 1 and < 0.3 g/g, respectively, at their last follow-up. Renal survival was better in patients who had initial urine PCR < 3 g/g as well as final PCR < 1 g/g. Regression analysis revealed that the final urine PCR and age were critical determinants of slope of the eGFR by both univariate and multivariate analyses. However, eGFR, pathologic findings, systolic BP, proteinuria, and body mass index at the initial presentation were not predictive of slope. CONCLUSION: Our results indicate that achieving a low urinary protein excretion is the main determinant for the good outcome in patients treated with combination therapy.
Authors:
S Choi; D Lee; K-H Jeong; J-Y Moon; S H Lee; T-W Lee; C-G Ihm
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Clinical nephrology     Volume:  72     ISSN:  0301-0430     ISO Abbreviation:  Clin. Nephrol.     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-10-29     Completed Date:  2010-01-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0364441     Medline TA:  Clin Nephrol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  353-9     Citation Subset:  IM    
Affiliation:
Department of Nephrology, College of Medicine, Kyung-Hee University, Seoul, South Korea.
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MeSH Terms
Descriptor/Qualifier:
Adult
Angiotensin II Type 1 Receptor Blockers / administration & dosage*
Antihypertensive Agents / administration & dosage
Creatinine / urine
Disease Progression
Drug Therapy, Combination
Female
Glomerular Filtration Rate
Glomerulonephritis, IGA / drug therapy*,  pathology,  physiopathology
Glucocorticoids / administration & dosage*
Humans
Kidney / pathology,  physiopathology
Male
Prednisolone / administration & dosage*
Prognosis
Proteinuria
Chemical
Reg. No./Substance:
0/Angiotensin II Type 1 Receptor Blockers; 0/Antihypertensive Agents; 0/Glucocorticoids; 50-24-8/Prednisolone; 60-27-5/Creatinine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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