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document
Controlled prospective trial of prednisolone and cytotoxics in progressive IgA nephropathy . In a single-center , multiple-referral source study , 38 patients with progressive IgA nephropathy and controlled hypertension were randomized to treatment with prednisolone and cytotoxic agents , to therapy with low-dose cyclophosphamide then azathioprine , and to control groups . The follow-up period lasted 2 to 6 yr. Renal survival , as assessed by Kaplan-Meier analysis annually to 5 yr , showed significant preservation of function from 3 yr in the treatment group and 82 , 82 , 72 , and 72 % for 2 , 3 , 4 , and 5 yr , respectively , compared with 68 , 47 , 26 , and 6 % in controls . Rate of loss of renal function , evaluated objectively by least-squares analyses of reciprocal serum creatinine , was reduced-and in one-third of the patients , arrested-during immunosuppressive treatment . Proteinuria , present in all patients at the time of entry into the trial , was reduced by treatment from 12 mo , compared with pretreatment levels or controls ; erythrocyturia was reduced from 6 mo . Histologic activity and chronicity indexes were determined in renal biopsies performed at trial entry . Multivariate analysis demonstrated that mesangial cell proliferation and matrix scores were highest in those patients with more rapidly progressive disease . No morphologic variable or residual renal function predicted response to immunosuppressive therapy at entry . Mean arterial pressures did not differ significantly between treatment and control groups . There was thus no explanation other than treatment for the improved outcome in patients who received immunosuppressive therapy . Morbidity attributable to treatment or to renal failure occurred in both groups ; an audit showed that benefits of therapy outweighed expected or minor side effects of drugs in this population at risk of end-stage renal failure . Patients selected for moderately progressive IgA nephropathy benefit from treatment with prednisolone and cytotoxic agents ; results are consistent with modulation of systemic immune response or nephritic injury , thus explaining improved outcome , and indicate that this therapy has an acceptably low risk of side effects .
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Intervention_Pharmacological
prednisolone and cytotoxics
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Intervention_Pharmacological
prednisolone and cytotoxic agents
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Intervention_Pharmacological
low-dose cyclophosphamide
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Intervention_Pharmacological
azathioprine
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Intervention_Control
control groups .
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Intervention_Pharmacological
prednisolone
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Intervention_Pharmacological
cytotoxic agents ;
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Outcome_Physical
loss of renal function
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Outcome_Physical
least-squares analyses of reciprocal serum creatinine
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Outcome_Physical
Proteinuria
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Outcome_Physical
erythrocyturia
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Outcome_Physical
Histologic activity
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Outcome_Physical
chronicity indexes
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Outcome_Other
Multivariate analysis
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Outcome_Physical
mesangial cell proliferation and matrix scores
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Outcome_Physical
morphologic variable or residual renal function
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Outcome_Physical
Mean arterial pressures
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Outcome_Physical
Morbidity
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Outcome_Physical
renal failure
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Outcome_Other
benefits of therapy
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Outcome_Physical
progressive IgA nephropathy
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Outcome_Adverse-effects
side effects
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Participant_Condition
progressive IgA nephropathy
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Participant_Sample-size
38
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Participant_Condition
progressive IgA nephropathy
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Participant_Condition
hypertension
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Participant_Condition
Proteinuria
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Participant_Condition
moderately progressive IgA nephropathy