Combined Therapy of Cyclophosphamide and Steroid on Progressive IgA Nephropathy

Cho, Sung Yeon; Choi, So Young; Lee, Dong Young; Moon, Ju Young; Jung, Kyung Hwan; Lee, Sang Ho; Lee, Tae Won; Lim, Chun Kyu

Abstract

PURPOSE
There were several reports showing that combined therapy of steroid and cyclophosphamide (PSL+CPA) was effective on progressive IgA nephropathy, but it remains inconclusive.
METHODS
Patients with IgA nephropathy who showed more than 1.5 mg/dL of serum creatinine (SCr) and proteinuria and who were treated with the combined therapy in the Kyung hee University Hospital.
RESULTS
The subjects were fifteen patients whose age was 40.3+/-10.8 yr, and the follow-up period was 39.1+/-24.6 months. Proteinuria levels declined from 4.08+/-2.58 g/gCr baseline to 1.80+/-1.72 g/ gCr 6 months after the treatment (p<0.0001). The comparison between the levels before & 6 months after the delta eGFR showed the improvement from -1.16+/-6.29 mL/min/1.73m2/month to 0.84+/-1.63 mL/ min/1.73m2/month (p=0.21), while these differences did not reach the level of statistical significance. According to delta eGFR, when the subjects were divided into the responder group (8 patients) and the non-responder group (7 patients), the former was 1.69+/-1.88 mL/min/1.73m2/month and the latter was -0.14+/-0.15 mL/min/1.73m2/month with significant difference (p=0.0014). According to UPCR, the responder group (12 patients) and the non-responder group (3 patients), systolic pressure, glomerulosclerosis and proteinuria after 6 months were significantly different (p=0.0115). Also, according to progressing ESRD, the CKD group (7 patients) and ESRD group (8 patients), age and SCr have shown a significant difference (p=0.0064).
CONCLUSION
The combined therapy on progressive IgA nephropathy effectively reduced proteinuria and had protective effects on renal function in some patients. However, proteinuria and others were insufficient to be predictive factors on therapeutic responses. Large-scale prospective controlled studies may be necessary in the future.