Kanno Yoshihiko, Witt Martje, Okada Hirokazu, Nemoto Hironori, Sugahara Soichi, Nakamoto Hidetomo, Suzuki Hiromichi
Department of Nephrology, Saitama Medical School, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan.
Clin Exp Nephrol. 2003 Mar;7(1):48-51. doi: 10.1007/s101570300006.
No satisfactory treatment exists for IgA nephropathy (IgAN), especially in patients with severe histologic damage. Several trials using steroids combined with other therapies such as warfarin have demonstrated unremarkable results. We investigated the renoprotective effects of warfarin and steroids in IgAN patients with crescent formation.
Fifteen Japanese patients with IgAN were followed for up to 3 years. Crescent formation was recognized in over half of their glomeruli from renal biopsy specimens. Treatments consisted of either 0.5 mg/kg per day of prednisolone, or warfarin monotherapy. Blood pressure was controlled with long-acting calcium channel blockers and alpha-beta blockers. Serum creatinine and urinary protein excretion were evaluated at least every 2 months for 36 months.
Ten of the 15 patients completed the study. The serum creatinine levels had increased in both groups by 3 years, but significantly more so in the group treated with warfarin. However, they were not significantly different between the two groups as measured at the beginning and end of the study. Blood pressure for all patients in the study was maintained below 130/85 mmHg. Excluded from the study were 5 patients who experienced either peptic ulcers (n = 2, steroid group) or bleeding problems (n = 3, warfarin group).
These results suggest that corticosteroid therapy may assist in preventing deterioration of renal function in patients with IgAN accompanied by crescent formation. However, further study would be required to decide its usefulness.
对于IgA肾病（IgAN），目前尚无令人满意的治疗方法，尤其是对于组织学损伤严重的患者。几项使用类固醇联合其他疗法（如华法林）的试验结果并不显著。我们研究了华法林和类固醇对伴有新月体形成的IgAN患者的肾脏保护作用。
15例日本IgAN患者随访长达3年。肾活检标本显示超过半数肾小球有新月体形成。治疗方案包括每日0.5mg/kg泼尼松龙，或华法林单药治疗。使用长效钙通道阻滞剂和α-β阻滞剂控制血压。在36个月内至少每2个月评估一次血清肌酐和尿蛋白排泄情况。
15例患者中有10例完成了研究。两组患者的血清肌酐水平在3年内均有所升高，但华法林治疗组升高更为显著。然而，研究开始和结束时两组之间并无显著差异。研究中所有患者的血压均维持在130/85mmHg以下。有5例患者被排除在研究之外，其中2例（类固醇组）出现消化性溃疡，3例（华法林组）出现出血问题。
这些结果表明，皮质类固醇疗法可能有助于预防伴有新月体形成的IgAN患者肾功能恶化。然而，尚需进一步研究以确定其有效性。
