Additive effect of prednisolone and cyclophosphamide to ACE inhibitor alone in the treatment of IgA nephropathy

다국어 초록 (Multilingual Abstract)

Background and methods:It has not been clear whether immunosuppressive therapy favorably influences renal function and proteinuria in IgA nephropathy(IgAN). Angiotensin converting enzyme inhibitor(ACEi) has an anti-proteinuric effect in IgAN. A retrospective study was done to see whether the addition of immunosuppressive therapy to ACEi produces a more excellent anti-proteinuric effect and preserves better renal function than ACEi alone. A total of 49 patients with proteinuria>1.0g/day and serum creatinine concentrations<1.5 mg/dl were followed up from at least 1 year to 9 years. Among them, 25 patients were treated with the combination of cyclophosphamide, prednisolone and ACEi while the other 24 treated with ACEi alone.
Results:The combination therapy or ACEi alone both reduced proteinuria with significant value(the combination group: from 5.74 5.08 to 2.29 2.77 g/day, ACEi group: from 3.85 2.54 to 1.68 1.91 g/day), while no significant differences in reduction of proteinuria were noticed between two groups. There is no significant elevation of serum creatinine in both groups during follow-up(the combination group: from 0.91 0.20 to 1.03 0.38 mg/dL, ACEi group: from 0.93 0.27 to 0.99 0.37 mg/dL). This study showed no significant differences in the change in slope of 1/serum creatinine levels during the follow-up period between two groups.
Conclusion:According to this results, ACEi may be a valuable therapeutic agent due to its effectiveness in severe proteinuric adult patients with IgAN, avoiding serious side effects of immunosuppressive agents. And the addition of immunosuppressive drugs may have no additional therapeutic effect in these patients. One consideration is that large dose and over a long period of immunosuppressive therapy may be necessary to reach final conclusion.

목차 (Table of Contents)

• I. Introduction = 1
• II. Subjects and methods = 2
• III. Results = 3
• IV. Discussion = 8
• REFERENCE = 11
• ABSTRACT = 14