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Multicenter Study
. 2022 Jun;26(6):561-570.
doi: 10.1007/s10157-022-02190-4. Epub 2022 Feb 9.

Efficacy of combination therapy for childhood complicated focal IgA nephropathy

Yuya Aoto  1 , Takeshi Ninchoji  2 , Hiroshi Kaito  3 , Yuko Shima  4 , Junya Fujimura  5 , Naohiro Kamiyoshi  6 , Shingo Ishimori  7 , Koichi Nakanishi  8 , Shogo Minamikawa  9 , Shinya Ishiko  2 , Nana Sakakibara  2 , China Nagano  2 , Tomoko Horinouchi  2 , Tomohiko Yamamura  2 , Sadayuki Nagai  2 , Atsushi Kondo  2 , Yosuke Inaguma  3 , Ryojiro Tanaka  3 , Norishige Yoshikawa  10 , Kazumoto Iijima  2 , Kandai Nozu  2
Affiliations
Multicenter Study

Efficacy of combination therapy for childhood complicated focal IgA nephropathy

Yuya Aoto et al. Clin Exp Nephrol. 2022 Jun.

Abstract

Background: Patients with immunoglobulin A nephropathy who present with focal mesangial proliferation (focal IgAN) can have a relatively good prognosis, and renin-angiotensin system inhibitor (RAS-i) is commonly used as the initial treatment. However, there are some complicated focal IgAN cases with resistance to RAS-i treatment or nephrotic-range proteinuria. Thus, combination therapy including corticosteroids is often used. This study aimed to evaluate the efficacy of combination therapy for complicated focal IgAN cases by comparing to diffuse mesangial proliferation (diffuse IgAN).

Methods: We conducted a multicenter retrospective study on 88 children who received 2-year combination therapy. The participants were classified based on pathological severity: focal IgAN (n = 26) and diffuse IgAN (n = 62).

Results: In total, 26 patients with focal IgAN and 52 with diffuse IgAN achieved proteinuria disappearance within 2 years (100 vs. 83.9%, P = 0.03). Moreover, the time to proteinuria disappearance was significantly shorter in the focal IgAN group than in the diffuse IgAN group (2.9 vs. 4.2 months, P < 0.01) and all patients with focal IgAN achieved proteinuria disappearance within 8 months. At the last observation (8.6 vs. 10.4 years, P = 0.13), only patients with diffuse IgAN (n = 12) had greater than stage 2 chronic kidney disease. In terms of irreversible adverse events, one patient exhibited cataracts.

Conclusion: Combination therapy was significantly effective in patients with complicated focal IgAN. Moreover, the long-term prognosis was good, and the duration of combination therapy for complicated focal IgAN can be decreased to reduce adverse events.

Keywords: Combination therapy; Complicated focal mesangial proliferative IgA nephropathy; Relapse; Renin–angiotensin system inhibitor; Resistance.

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References

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