Division of Nephrology, Tokyo Metropolitan Health and Hospitals Corporation Ohkubo Hospital, 2-44-1 Kabuki-cho, Shinjyuku-ku, Tokyo, 160-8488, Japan.
Clin Exp Nephrol. 2022 Sep;26(9):859-866. doi: 10.1007/s10157-022-02226-9. Epub 2022 Apr 29.
Hematuria is the essential symptom of IgA nephropathy that has been suggested to be associated with long-term renal prognosis, Tonsillectomy and steroid pulse therapy (TSP), which is widely practiced in Japan, is effective for achieving hematuria remission. However, some cases are refractory to TSP, and additional steroid pulse therapy (SP) administered to these cases to achieve remission of hematuria. Nonetheless, the clinical significance of additional SP is unknown.
In this retrospective study, we enrolled 99 patients from Okubo Hospital whose hematuria persisted following TSP. Patients were divided into the hematuria remission and non-remission groups. A multivariate regression analysis was performed on the factors that contributed to hematuria remission.
Following TSP, 103 of 403 patients (32.3%) did not achieve hematuria remission. Additional SP were performed in 99 of these patients, and remission of hematuria was achieved in 57 (57.6%). Patients with a greater degree of improvement in hematuria with TSP were significantly more likely to have remission of hematuria with additional SP (p = 0.0084*). Even in the hematuria non-remission group, both hematuria and proteinuria improved after additional SP.
In IgA nephropathy, additional SP could induce hematuria remission and reduce proteinuria.
血尿是 IgA 肾病的基本症状，据报道与长期肾脏预后有关。扁桃体切除术和类固醇脉冲疗法（TSP）在日本被广泛应用，可有效实现血尿缓解。然而，有些病例对 TSP 无反应，需要对这些病例进行额外的类固醇脉冲疗法（SP）以实现血尿缓解。然而，额外 SP 的临床意义尚不清楚。
本回顾性研究纳入了来自大久保医院的 99 名血尿持续存在于 TSP 后的患者。患者分为血尿缓解组和非缓解组。对促成血尿缓解的因素进行多变量回归分析。
TSP 后，403 名患者中有 103 名（32.3%）未实现血尿缓解。对其中 99 名患者进行了额外的 SP，57 名（57.6%）实现了血尿缓解。TSP 血尿改善程度较大的患者，额外 SP 实现血尿缓解的可能性显著更高（p=0.0084*）。即使在血尿未缓解组，额外 SP 后血尿和蛋白尿均有改善。
在 IgA 肾病中，额外的 SP 可诱导血尿缓解并减少蛋白尿。
