Re-biopsy in a patient with IgA nephropathy showing success of treatment with cyclosporin A and angiotensin-II receptor blocker

We report a patient with IgA nephropathy (IgAN) showing reduction of proteinuria and histological improvement of renal injury with cyclosporin A (CsA) and angiotensin-II receptor blocker (ARB) therapy. The amount of urinary protein was reduced from 4.4 to 1.8 g/24 h after 2 months of CsA (150 mg/day) therapy, and further, to 0.4 g/24 h after 1 month of the combination therapy with ARB (candesartan, 4 mg/day). A renal re-biopsy, after treatment with CsA for 3 months and ARB for 1 month, demonstrated a reduction of IgA deposits, disappearance of crescents, re-separation of foot process fusion and decrease of interstitial cellular infiltration. After CsA therapy for 20 months and ARB for 18 months, the patient currently remains stable without deterioration of serum creatinine (1.7 mg/dl) and urinary protein excretion (0.5 g/day). These findings seem to indicate that combination therapy with CsA and ARB is effective for achieving histological improvement and protecting against deteriorated renal function, in addition to reducing proteinuria, in IgAN.