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      Use of low-dose sulodexide in IgA nephropathy patients on renin-angiotensin system blockades = Use of low-dose sulodexide in IgA nephropathy patients on renin-angiotensin system blockades

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      https://www.riss.kr/link?id=A102166509

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      다국어 초록 (Multilingual Abstract)

      Background: Despite using renin-angiotensin system (RAS) blockades, some of the patients with immunoglobulin A (IgA) nephropathy often had persistent proteinuria of more than 500 mg/d. They need to be managed further by alternative methods to halt the...

      Background: Despite using renin-angiotensin system (RAS) blockades, some of the patients with immunoglobulin A (IgA) nephropathy often had persistent proteinuria of more than 500 mg/d. They need to be managed further by alternative methods to halt the progression of the disease; these methods could also be applied safely over a long period of time. In this context, sulodexide has been studied for the management of diabetic nephropathy. Methods: A retrospective review was carried out involving 20 patients with IgA nephropathy who had been taking sulodexide (50 mg daily) as an add-on therapy together with an optimal dose of RAS blockades during 2008-2009. We evaluated the proteinuria reduction rates and renal function changes. Results: During 11.1±72.7 months of follow-up duration, urinary protein-to- creatinine ratio(UPCR) decreased for 1.57±0.6 to1.17±0.7 g/g (P=0.032). Twenty-five percent of the patients showed a greater than 50% reduction of UPCR, and 40% had a UPCR of less than 1.0 g/g at their final observations. The analysis of the factors contributing to the effect found that a higher pretreatment UPCR showed a significant correlation with the UPCR decrease (r=0.45, P=0.047). Neither the adverse effects nor the renal function impairments were documented during the management. Conclusion: Low-dose sulodexide has an additional modest antiproteinuric effect on IgA nephropathy undergoing RAS blockade therapy.

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      참고문헌 (Reference)

      1 Praga M, "Treatment of IgA nephropathy with ACE inhibitors: a randomized and controlled trial" 14 : 1578-1583, 2003

      2 Barratt J, "Treatment of IgA nephropathy" 69 : 1934-1938, 2006

      3 Sharma SG, "The significance of foot process effacement in immunoglobulin a nephropathy: clinicopathologic study of 161 cases with light, immunofluorescence and electron microscopic studies" 34 : 269-272, 2010

      4 D'Amico G, "The commonest glomerulonephritis in the world: IgA nephropathy" 64 : 709-727, 1987

      5 Tomino Y, "Special Study Group (IgA nephropathy) on Progressive Glomerular Disease: Clinical guidelines for immunoglobulin A (IgA) nephropathy in Japan, second version" 7 : 93-97, 2003

      6 Churg J, "Renal Disease: Classification and Atlas of Glomerular Disease" Igaku-Shoin 1982

      7 Lambers Heerspink HJ, "Rationale for and study design of the sulodexide trials in type 2 diabetic, hypertensive patients with microalbuminuria or overt nephropathy" 24 : 1290-1295, 2007

      8 Manno C, "Randomized controlled clinical trial of corticosteroids plus ACE-inhibitors with long-term follow-up in proteinuric IgA nephropathy" 24 : 3694-3701, 2009

      9 Chen S, "Protective effect of sulodexide on podocyte injury in adriamycin nephropathy rats" 29 : 715-719, 2009

      10 Ishii T, "Prospective trial of combined therapy with heparin/warfarin and renin–angiotensin system inhibitors in progressive IgA nephropathy" 157 : 114-119, 2007

      1 Praga M, "Treatment of IgA nephropathy with ACE inhibitors: a randomized and controlled trial" 14 : 1578-1583, 2003

      2 Barratt J, "Treatment of IgA nephropathy" 69 : 1934-1938, 2006

      3 Sharma SG, "The significance of foot process effacement in immunoglobulin a nephropathy: clinicopathologic study of 161 cases with light, immunofluorescence and electron microscopic studies" 34 : 269-272, 2010

      4 D'Amico G, "The commonest glomerulonephritis in the world: IgA nephropathy" 64 : 709-727, 1987

      5 Tomino Y, "Special Study Group (IgA nephropathy) on Progressive Glomerular Disease: Clinical guidelines for immunoglobulin A (IgA) nephropathy in Japan, second version" 7 : 93-97, 2003

      6 Churg J, "Renal Disease: Classification and Atlas of Glomerular Disease" Igaku-Shoin 1982

      7 Lambers Heerspink HJ, "Rationale for and study design of the sulodexide trials in type 2 diabetic, hypertensive patients with microalbuminuria or overt nephropathy" 24 : 1290-1295, 2007

      8 Manno C, "Randomized controlled clinical trial of corticosteroids plus ACE-inhibitors with long-term follow-up in proteinuric IgA nephropathy" 24 : 3694-3701, 2009

      9 Chen S, "Protective effect of sulodexide on podocyte injury in adriamycin nephropathy rats" 29 : 715-719, 2009

      10 Ishii T, "Prospective trial of combined therapy with heparin/warfarin and renin–angiotensin system inhibitors in progressive IgA nephropathy" 157 : 114-119, 2007

      11 Choi S, "Prognostic relevance of clinical and histological features in IgA nephropathy treated with steroid and angiotensin receptor blockers" 72 : 353-359, 2009

      12 Alamartine E, "Prognostic factors in mesangial IgA glomerulonephritis: an extensive study with univariate and multivariate analyses" 18 : 12-19, 1991

      13 Remuzzi G, "Pathophysiology of progressive nephropathies" 339 : 1448-1556, 1998

      14 Gambaro G, "Oral sulodexide reduces albuminuria in microalbuminuric and macroalbuminuric type 1 and type 2 diabetic patients: the Di.N.A.S. randomized trial" 13 : 1615-1625, 2002

      15 Szeto CC, "Oral calcitriol for the treatment of persistent proteinuria in immunoglobulin A nephropathy: an uncontrolled trial" 51 : 724-731, 2008

      16 Liu LJ, "Oral calcitriol for reduction of proteinuria in patients with IgA nephropathy: a randomized controlled trial" 59 : 67-74, 2012

      17 Achour A, "One year course of oral sulodexide in the management of diabetic nephropathy" 18 : 568-574, 2005

      18 Burney BO, "Novel therapies of diabetic nephropathy" 18 : 107-111, 2009

      19 D'Amico G, "Natural history of idiopathic IgA nephropathy: role of clinical and histological prognostic factors" 36 : 227-237, 2000

      20 Ishikawa Y, "Inhibition of glomerular cell apoptosis by heparin" 56 : 954-963, 1999

      21 Daniels BS, "Increased albumin permeability in vitro following alterations of glomerular charge is mediated by the cells of the filtration barrier" 124 : 224-230, 1994

      22 Glassock RJ, "Immunoglobulin A nephropathy, In Treatment of Primary Glomerulonephritis. 2nd edition" Oxford University Press 313-374, 2009

      23 Coppo R, "IgACE: a placebo-controlled, randomized trial of angiotensin-converting enzyme inhibitors in children and young people with IgA nephropathy and moderate proteinuria" 18 : 1880-1888, 2007

      24 Maxhimer JB, "Heparanase-1 gene expression and regulation by high glucose in renal epithelial cells: a potential role in the pathogenesis of proteinuria in diabetic patients" 54 : 2172-2178, 2005

      25 Solini A, "Glycosaminoglycans delay the progression of nephropathy in NIDDM" 20 : 819-823, 1997

      26 Ceol M, "Glycosaminoglycan therapy prevents TGF-beta1 overexpression and pathologic changes in renal tissue of long-term diabetic rats" 11 : 2324-2336, 2000

      27 Skrha J, "Glycosaminoglycan sulodexide decreases albuminuria in diabetic patients" 38 : 25-31, 1997

      28 Sorrenti G, "Glycoaminoglycans as a possible tool for micro- and macroalbuminuria in diabetic patients. A pilot study" 25 : 81-86, 1997

      29 Nachman PH, "Glomerular, vascular, and tubulointerstitial diseases" 9 : 119-211, 2010

      30 Blouza S, "Efficacy of low-dose oral sulodexide in the management of diabetic nephropathy" 23 : 415-424, 2010

      31 Cheng J, "Efficacy and safety of glucocorticoids therapy for IgA nephropathy: a meta- analysis of randomized controlled trials" 30 : 315-322, 2009

      32 Poplawska A, "Effect of glycosaminoglycans on urinary albumin excretion in insulin-dependent diabetic patients with micro- or macroalbuminuria" 38 : 109-114, 1997

      33 Lai KN, "Corticosteroid therapy in IgA nephropathy with nephritic syndrome: a long-term controlled trial" 26 : 174-180, 1986

      34 Pozzi C, "Corticosteroid effectiveness in IgA nephropathy: long-term results of a randomized, controlled trial" 15 : 157-163, 2004

      35 Goumenos DS, "Conservative management, immunosuppressive treatment or both for patients with primary immunoglobulin a nephropathy" 2 : 56-60, 2010

      36 Lv J, "Combination therapy of prednisone and ACE inhibitor versus ACE-inhibitor therapy alone in patients with IgA nephropathy: a randomized controlled trial" 53 : 26-32, 2009

      37 Lewis EJ, "Collaborative Study Group: Sulodexide for kidney protection in type 2 diabetes patients with microalbuminuria: a randomized controlled trial" 58 : 729-736, 2011

      38 Packham DK, "Collaborative Study Group: Sulodexide fails to demonstrate renoprotection in overt type 2 diabetic nephropathy" 23 : 123-130, 2012

      39 Kitae Bang, "Anti-Proteinuric Effect of Sulodexide in Immunoglobulin A Nephropathy" 연세대학교의과대학 52 (52): 588-594, 2011

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