Pozzi C, Del Vecchio L, Locatelli F
Divisione di Nefrologia e Dialisi, Ospedale A. Manzoni, Lecco, Italy.
G Ital Nefrol. 2002 Sep-Oct;19(5):523-8.
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.
对于伴有慢性肾衰竭（CRF）的IgA肾病（IgAN）患者，免疫抑制治疗仍是一个存在争议的问题，这是因为人们对治疗预期效果及可能的副作用持怀疑态度。存在一个“不可逆转点”（血清肌酐为3mg/dL），超过此点后肾功能恶化将不可避免。我们报告了一例24岁患有晚期IgAN（血清肌酐>3mg/dL）的女性患者，在接受为期6个月的类固醇疗程治疗后，蛋白尿缓解且肾功能长期稳定。关于IgAN晚期治疗的文献资料并不充分。我们的多中心随机对照试验旨在评估为期6个月的类固醇疗程的效果，基线时纳入了18例轻度CRF患者。我们治疗的10例患者的肾脏生存率优于未接受类固醇治疗的8例患者，预期肾脏生存率分别为29.5年和6.5年。在一项针对血清肌酐为1.6 - 2.9mg/dl患者的前瞻性研究中，巴拉迪和罗伯茨比较了19例接受免疫抑制药物治疗的患者和19例对照患者：治疗组5年肾脏生存率为72%，对照组为5%。古梅诺斯等人回顾性评估了39例接受类固醇和硫唑嘌呤治疗的患者以及22例未治疗患者：79.5%的治疗患者和36%的未治疗患者观察到病情无进展。鹤谷等人回顾性检查了接受类固醇和环磷酰胺治疗的26例患者以及19例未治疗患者：治疗组和未治疗组患者的预期肾脏生存率分别为5.2年和4.8年。前瞻性对照试验对于评估免疫抑制治疗在肾功能受损的IgAN患者中的实际疗效至关重要。我们最近提议开展一项研究，比较单独使用类固醇和类固醇加硫唑嘌呤的效果，因为必须寻找安全有效的疗法，尽可能推迟透析的开始时间，对于已经确诊CRF的患者也是如此。
