PMID- 12439840
OWN - NLM
STAT- MEDLINE
DCOM- 20030121
LR  - 20131121
IS  - 0393-5590 (Print)
IS  - 0393-5590 (Linking)
VI  - 19
IP  - 5
DP  - 2002 Sep-Oct
TI  - [Immunosuppressive therapy in IgA glomerulonephritis with chronic renal failure: 
      case study presentation and literature review].
PG  - 523-8
AB  - Immunosuppressive treatment of IgA Nephropathy (IgAN) with chronic renal failure 
      (CRF) is still a controversial issue, because of scepticism on expected results 
      and possible side effects of therapy. There is a "point of no return" (serum 
      creatinine of 3 mg/dL), after which the deterioration of renal function becomes 
      inevitable. We report the case of a 24-year-old woman, with advanced IgAN (serum 
      creatinine > 3 mg/dL), who experienced remission of proteinuria and long-lasting 
      stabilisation of renal function, after treatment with a 6-month steroid course. 
      Literature information on the therapy for advanced phases of IgAN is inadequate. 
      Our multicenter randomised controlled trial, aimed at evaluating the effects of a 
      6-month steroid course, included 18 patients with mild CRF at baseline. The ten 
      patients that we treated experienced better renal survival than the eight 
      patients who received no steroids, with an expected renal survival of 29.5 and 
      6.5 years, respectively. In a prospective study of patients with serum creatinine 
      of 1.6 - 2.9 mg/dl, Ballardie and Roberts compared 19 patients treated with 
      immunosuppressive drugs and 19 control patients: renal survival at 5 years was 
      72% in treated and 5% in control patients. Goumenos et al. retrospectively 
      evaluated 39 patients treated with steroids and azathioprine and 22 untreated 
      patients: a non-progressive course was observed in 79.5% of treated patients and 
      in 36% of untreated patients. Tsuruya et al. retrospectively examined 26 patients 
      treated with steroids and cyclophosphamide and 19 untreated patients: the 
      expected renal survival was of 5.2 years in treated and 4.8 years in untreated 
      patients, respectively. Prospective controlled trials are essential for 
      evaluating the real effectiveness of immunosuppressive therapy in IgAN patients 
      with impaired renal function. We have recently proposed a study to compare 
      steroids alone and steroids plus azathioprine, because it is mandatory to look 
      for safe and effective therapies that delay as much as possible the start of 
      dialysis, also in patients with already established CRF.
FAU - Pozzi, C
AU  - Pozzi C
AD  - Divisione di Nefrologia e Dialisi, Ospedale A. Manzoni, Lecco, Italy. 
      nefrologia@ospedale.lecco.it
FAU - Del Vecchio, L
AU  - Del Vecchio L
FAU - Locatelli, F
AU  - Locatelli F
LA  - ita
PT  - Case Reports
PT  - Clinical Trial
PT  - English Abstract
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Review
TT  - La terapia immunosoppressiva nella glomerulonefrite IgA con insufficienza renale 
      cronica: presentazione di un caso.
PL  - Italy
TA  - G Ital Nefrol
JT  - Giornale italiano di nefrologia : organo ufficiale della Societa italiana di 
      nefrologia
JID - 9426434
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - 0 (Immunosuppressive Agents)
RN  - 69PN84IO1A (Enalapril)
RN  - AYI8EX34EU (Creatinine)
RN  - VB0R961HZT (Prednisone)
SB  - IM
MH  - Adult
MH  - Angiotensin-Converting Enzyme Inhibitors/therapeutic use
MH  - Creatinine/blood
MH  - Disease Progression
MH  - Drug Therapy, Combination
MH  - Enalapril/therapeutic use
MH  - Female
MH  - Glomerulonephritis, IGA/complications/*drug therapy
MH  - Humans
MH  - Immunosuppressive Agents/administration & dosage/*therapeutic use
MH  - Kidney Failure, Chronic/*drug therapy/etiology
MH  - Kidney Function Tests
MH  - Prednisone/administration & dosage/*therapeutic use
MH  - Proteinuria/drug therapy/etiology
MH  - Remission Induction
RF  - 16
EDAT- 2002/11/20 04:00
MHDA- 2003/01/22 04:00
CRDT- 2002/11/20 04:00
PHST- 2002/11/20 04:00 [pubmed]
PHST- 2003/01/22 04:00 [medline]
PHST- 2002/11/20 04:00 [entrez]
PST - ppublish
SO  - G Ital Nefrol. 2002 Sep-Oct;19(5):523-8.