IgA nephropathy in Greece: data from the registry of the Hellenic Society of Nephrology

Abstract Background Natural history, predisposing factors to an unfavourable outcome and the effect of various therapeutic regimens were evaluated in a cohort of 457 patients with immunoglobulin A nephropathy (IgAN) and follow-up of at least 12 months. Methods Patients with normal renal function and...

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Veröffentlicht in:Clinical kidney journal 2018-02, Vol.11 (1), p.38-45
Hauptverfasser: Stangou, Maria, Papasotiriou, Marios, Xydakis, Dimitrios, Oikonomaki, Theodora, Marinaki, Smaragdi, Zerbala, Synodi, Stylianou, Constantinos, Kalliakmani, Pantelitsa, Andrikos, Aimilios, Papadaki, Antonia, Balafa, Olga, Golfinopoulos, Spyridon, Visvardis, Georgios, Moustakas, Georgios, Papachristou, Evangelos, Kouloukourgiotou, Theodora, Kapsia, Eleni, Panagiotou, Angeliki, Koulousios, Constantinos, Kavlakoudis, Christos, Georgopoulou, Maria, Panagoutsos, Stylianos, Vlahakos, Demetrios V, Apostolou, Theophanis, Stefanidis, Ioannis, Siamopoulos, Kostas, Tzanakis, Ioannis, Papadogiannakis, Apostolos, Daphnis, Eugene, Iatrou, Christos, Boletis, John N, Papagianni, Aikaterini, Goumenos, Dimitrios S
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Sprache:eng
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Zusammenfassung:Abstract Background Natural history, predisposing factors to an unfavourable outcome and the effect of various therapeutic regimens were evaluated in a cohort of 457 patients with immunoglobulin A nephropathy (IgAN) and follow-up of at least 12 months. Methods Patients with normal renal function and proteinuria 2.5 mg/dL and/or severe glomerulosclerosis received no treatment. Patients with normal or impaired renal function and proteinuria >1 g/24 h for >6 months received daily oral prednisolone or a 3-day course of intravenous (IV) methylprednisolone followed by oral prednisolone per os every other day or a combination of prednisolone and azathioprine. The clinical outcome was estimated using the primary endpoints of end-stage renal disease and/or doubling of baseline SCr. Results The overall 10-year renal survival was 90.8%, while end-stage renal disease and doubling of baseline SCr developed in 9.2% and 14.7% of patients, respectively. Risk factors related to the primary endpoints were elevated baseline SCr, arterial hypertension, persistent proteinuria >0.5 g/24 h and severity of tubulointerstial fibrosis. There was no difference in the clinical outcome of patients treated by the two regimens of corticosteroids; nevertheless, remission of proteinuria was more frequent in patients who received IV methylprednisolone (P = 0.000). The combination of prednisolone with azathioprine was not superior to IV methylprednisolone followed by oral prednisolone. Side effects related to immunossuppressive drugs were observed in 12.8% of patients. Conclusion The clinical outcome of patients with IgAN was related to the severity of clinical and histological involvement. The addition of azathioprine to a corticosteroid-based regimen for IgAN does not improve renal outcome.
ISSN:2048-8505
2048-8513
DOI:10.1093/ckj/sfx076