A controlled trial of combined therapy for newly diagnosed severe childhood IgA nephropathy

Norishige Yoshikawa, Hiroshi Ito, Tadasu Sakai, Yasuo Takekoshi, Masataka Honda, Midori Awazu, Katsumi Ito, Kikuo Iitaka, Yasushi Koitabashi, Kanji Yamaoka, Kimiko Nakagawa, Hajime Nakamura, Souichirou Matsuyama, Yoshiki Seino, Nobuaki Takeda, Shinzaburou Hattori, Makoto Ninomiya

Research output: Contribution to journalArticlepeer-review

169 Citations (Scopus)

Abstract

The most appropriate treatment for patients with IgA nephropathy is controversial. Treatment with prednisolone, azathioprine, heparin-warfarin, and dipyridamole early in the course of disease may prevent immunologic renal injury in children with severe IgA nephropathy. To determine whether similar results can be obtained with a combination of just heparin-warfarin and dipyridamole, the effects of such treatment were compared to those of treatment with prednisolone, azathioprine, heparin-warfarin, and dipyridamole in 78 children with newly diagnosed IgA nephropathy showing diffuse mesangial proliferation. The patients were randomly assigned to receive either prednisolone, azathioprine, heparin-warfarin, and dipyridamole for 2 yr (group 1) or heparin-warfarin and dipyridamole for 2 yr (group 2). All of the 40 patients in group 1 and 34 of the 38 patients in group 2 completed the trial. The mean urinary protein excretion fell in group 1 patients (P ≤ 0.0001), but remained unchanged in group 2 patients. The mean serum IgA concentration was reduced in group I patients (P = 0.0002), but was unchanged in group 2 patients. BP and creatinine clearance were normal at the end of the trial in all but one group 2 patient, who developed chronic renal insufficiency. The percentage of glomeruli showing sclerosis was unchanged in group 1 patients, but increased in group 2 patients (P = 0.006). The intensity of mesangial IgA deposits decreased in group 1 patients (P = 0.02), but remained unchanged in group 2 patients. In conclusion, the present study shows that treatment of children with severe IgA nephropathy with prednisolone, azathioprine, heparin-warfarin, and dipyridamole for 2 yr early in the course of disease reduces immunologic renal injury and prevents increase of sclerosed glomeruli.

Original languageEnglish
Pages (from-to)101-109
Number of pages9
JournalJournal of the American Society of Nephrology
Volume10
Issue number1
Publication statusPublished - 1999 Jan 1

ASJC Scopus subject areas

  • Nephrology

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