Korean J Intern Med.  2001 Jun;16(2):105-109.

Clinical Course of Patients with IgA Nephropathy between Combined Treatment of Immunosuppressive Agents and ACE Inhibitor and ACE Inhibitor alone

• Hwang YC
• Lee TW
• Kim MJ
• Yang MH
• Ihm CG

Abstract

BACKGROUND: 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. METHODS: A total of 49 patients with proteinuria>1.0 g/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 were 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 the two groups. There was 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 the two groups. CONCLUSION: We conclude that immunosuppressive therapy may not be beneficial in patients with proteinuric IgAN. ACEi may be a valuable therapeutic agent avoiding serious side effects of immunosuppressive agents.

Keyword

Glomerulonephritis; IGA; Prednisolone; Cyclophosphamide; Angiotensin-converting enzyme inhibitors; Proteinuria; Renal function

MeSH Terms

Adolescent
Adult
Aged
Angiotensin-Converting Enzyme Inhibitors/*administration & dosage
Comparative Study
Cyclophosphamide/*administration & dosage
Drug Therapy, Combination
Female
Follow-Up Studies
Glomerulonephritis, IGA/diagnosis/*drug therapy
Human
Immunosuppressive Agents/*administration & dosage
Kidney Function Tests
Male
Middle Age
Prednisolone/*administration & dosage
Probability
Retrospective Studies
Severity of Illness Index
Statistics, Nonparametric
Treatment Outcome