Department of Medicine IV, University Freiburg, Medical Center, Freiburg, Germany.
Kidney360. 2022 Jan 19;3(3):506-515. doi: 10.34067/KID.0006702021. eCollection 2022 Mar 31.
IgA nephropathy (IgAN) is the most common primary glomerulonephritis in adults, which causes ESKD in ≤45% of patients in the long term. The optimal therapeutic approach remains undetermined. In this study, we report the results of a single-center retrospective analysis of patients with IgAN.
We retrospectively evaluated the therapeutic approach and outcome of all patients at our center with biopsy-proven IgAN between 2000 and 2020, focusing on the effect of intravenous cyclophosphamide therapy combined with glucocorticoids ("immunosuppressive therapy group"). The control group received standard supportive care.
Patients in the immunosuppressive therapy group had worse kidney function before the initiation of therapy, as indicated by higher serum creatinine, more proteinuria, and a higher degree of hematuria than the control group; they also displayed a higher body mass index. The Oxford classification of IgA nephropathy (MEST-C score) suggested more inflammatory activity in the immunosuppressive therapy group, including more crescents and endocapillary hypercellularity. During the follow-up, proteinuria and hematuria decreased in both groups, and to a significantly greater extent in the immunosuppressive therapy group. Cyclophosphamide treatment significantly improved kidney function as determined by the fold-change of eGFR during the observation period. The number of infections and hospitalizations did not differ, but the incidence of diabetes was increased in the immunosuppressive therapy group.
This study suggests immunosuppressive therapy with cyclophosphamide combined with glucocorticoids improves kidney function, proteinuria, and hematuria. The therapy was safe for infectious complications, but was associated with an increased incidence of diabetes, which might be attributable in part to the use of steroids in patients with a higher body mass index at baseline. Although immunosuppressive therapy in IgAN remains controversial, our findings suggest that at least some patients benefit from more aggressive therapy.
IgA 肾病（IgAN）是成人中最常见的原发性肾小球肾炎，在长期内导致 ≤45%的患者发展为终末期肾病。最佳治疗方法仍未确定。在本研究中，我们报告了对 2000 年至 2020 年间在我们中心接受活检证实的 IgAN 患者的单中心回顾性分析结果。
我们回顾性评估了我们中心所有接受活检证实的 IgAN 患者的治疗方法和结局，重点关注静脉注射环磷酰胺联合糖皮质激素治疗（“免疫抑制治疗组”）的效果。对照组接受标准支持治疗。
免疫抑制治疗组患者在开始治疗前肾功能较差，表现为血清肌酐更高、蛋白尿更多、血尿程度更高，且体重指数更高；牛津 IgA 肾病分类（MEST-C 评分）提示免疫抑制治疗组炎症活动程度更高，包括更多新月体和内皮下细胞增多。在随访期间，两组患者的蛋白尿和血尿均减少，免疫抑制治疗组减少更为显著。环磷酰胺治疗可显著改善肾功能，表现为观察期间 eGFR 的变化倍数。感染和住院的次数没有差异，但免疫抑制治疗组糖尿病的发病率增加。
本研究表明，环磷酰胺联合糖皮质激素的免疫抑制治疗可改善肾功能、蛋白尿和血尿。该治疗方案对感染并发症是安全的，但与糖尿病发病率增加有关，这可能部分归因于基线时体重指数较高的患者使用了类固醇。尽管 IgAN 的免疫抑制治疗仍存在争议，但我们的研究结果表明，至少一些患者受益于更积极的治疗。
