Kohagura Kentaro, Arima Hisatomi, Miyasato Hitoshi, Chang Tung-Huei, Yamazato Masanobu, Kobori Hiroyuki, Nishiyama Akira, Iseki Kunitoshi, Ohya Yusuke
Dialysis Unit, University of the Ryukyus Hospital, Okinawa, Japan,
Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan,
Kidney Blood Press Res. 2018;43(3):780-792. doi: 10.1159/000489914. Epub 2018 May 22.
BACKGROUND/AIMS: Angiotensin receptor blockers (ARBs) may be beneficial for clinical remission during conventional therapy with tonsillectomy and steroid pulse (TSP) for active IgA nephropathy.
Seventy-seven patients with active IgA nephropathy were randomly assigned to the control arm with conventional regimen (TSP followed by oral prednisolone) (n = 37) or the ARB arm with conventional regimen plus ARB candesartan for the first 6 months (n = 40). Patients not achieving proteinuria remission at 12 months in either arm were administered candesartan, which was titrated until the 24-month follow-up. The primary endpoints were remission of proteinuria (< 0.3 g/gCr) and hematuria at 12 months.
Baseline proteinuria (g/g Cr) were comparable between the control and ARB arm (1.02 vs. 0.97, P = 0.97). Similarly, cumulative remission rates at 6, 12, and 24 months were comparable between the control and ARB arms (37.8% vs. 35% [P = 0.80], 48.7% vs. 38.5% [P = 0.37], 71.4% vs. 51.3% [P = 0.08]). Proteinuria, which was slightly worse in the control arm than in the ARB arm at 6 months, was comparable afterwards (0.20 vs. 0.23 g/g Cr at 12 months; 0.12 vs. 0.13 g/g Cr at 24 months). Significant reductions observed in urinary angiotensinogen were almost comparable between the two treatment arms at both 6 and 12 months.
Early candesartan treatment combined with TSP may not benefit clinical remission regardless of the blood pressure. ARB titration later during the treatment might provide benefit for patients with active IgA nephropathy.
背景/目的：对于活动性IgA肾病患者，在扁桃体切除和类固醇冲击治疗（TSP）的传统疗法期间，血管紧张素受体阻滞剂（ARB）可能有助于临床缓解。
77例活动性IgA肾病患者被随机分为对照组（采用传统方案，即TSP后口服泼尼松龙）（n = 37）或ARB组（在前6个月采用传统方案加ARB坎地沙坦）（n = 40）。在任何一组中12个月时未实现蛋白尿缓解的患者给予坎地沙坦，滴定剂量直至24个月随访结束。主要终点是12个月时蛋白尿（< 0.3 g/gCr）和血尿的缓解情况。
对照组和ARB组的基线蛋白尿（g/g Cr）相当（1.02对0.97，P = 0.97）。同样，对照组和ARB组在6、12和24个月时的累积缓解率相当（37.8%对35% [P = 0.80]，48.7%对38.5% [P = 0.37]，71.4%对51.3% [P = 0.08]）。6个月时对照组的蛋白尿略比ARB组严重，之后两组相当（12个月时为0.20对0.23 g/g Cr；24个月时为0.12对0.13 g/g Cr）。在6个月和12个月时，两个治疗组中观察到的尿血管紧张素原的显著降低几乎相当。
早期坎地沙坦治疗联合TSP可能对临床缓解无益，无论血压如何。治疗后期进行ARB滴定可能对活动性IgA肾病患者有益。
