Meng Mei-Juan, Hu Ling, Fan Yun, Gao Han, Chen Han-Zhi, Chen Cai-Mei, Qi Zhen, Liu Bin
Department of Nephrology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi 214023, Jiangsu Province, China.
World J Clin Cases. 2023 Dec 16;11(35):8300-8309. doi: 10.12998/wjcc.v11.i35.8300.
Immunoglobulin A nephropathy (IgAN) is a common form of chronic glomerulonephritis. Currently, IgAN is one of the main causes of chronic renal failure in China; its prognosis varies greatly between patients, with renal function at the time of diagnosis and prognosis being strongly correlated. Mycophenolate mofetil (MMF) is a drug with a good immunomodulatory effect and is commonly used clinically. However, its effects in IgAN have not yet been clearly demonstrated. Therefore, herein, we retrospectively compared the effectiveness and safety of prednisone alone or combined with MMF for the treatment of primary IgAN with moderate-to-severe renal impairment.
To evaluate the effectiveness and safety of prednisone and MMF in treating IgAN with moderate-to-severe renal dysfunction.
Between January 2011 and December 2020, 200 patients with moderate-to-severe IgAN were included in this study, all of whom were admitted to Wuxi People's Hospital affiliated with Nanjing Medical University. All patients underwent a renal puncture biopsy, which revealed primary IgAN with a glomerular filtration rate (GFR) of 30-60 mL/min. The patients were divided into a glucocorticoid therapy group (GTG) and an immunosuppressive therapy group (ITG) according to the different treatment regimens, with 100 patients in each group. Based on general treatments, such as angiotensin-converting enzyme inhibitors/ angiotensin receptor blockers, patients in the GTG were administered prednisone 0.5-0.8 mg/ (kg·d) for 4-8 wk, which was reduced by 5 mg every two weeks until the maintenance(30 mg/d) dose was reached and maintained for 12 mo. In the ITG, MMF was administered at 1.0 g/d for 6-12 mo, followed by a maintenance dosage of 0.5 g/d for 12 mo. Age, sex, blood pressure, 24-h urinary egg white measurement, serum creatinine (Scr), blood uric acid, blood albumin, blood potassium (K), hemoglobin, GFR, alanine aminotransferase, total cholesterol (T-CHO), fasting blood glucose, and body mass index were recorded. The 24-h urinary protein, Scr, and GFR levels were recorded 3, 6, 9, and 12 mo after treatment. Follow-up data were also collected.
No discernible differences existed between the two groups in terms of age, sex, blood pressure, creatinine, 24-h urinary protein level, GFR, or other biochemical indicators at the time of enrollment. Both regimens significantly reduced the 24-h urinary protein quantitation and stabilized renal function. Nine months after treatment, the 24-h urinary protein and Scr of the ITG decreased more significantly than those of the GTG. By the 12 month of treatment, the 24-h urinary protein and Scr in both groups continued to decrease compared to those by the 9 month. In addition, the overall response rate in the ITG was significantly higher than that in the GTG. The occurrence of side effects did not vary significantly between the two regimens; however, endpoint events were significantly more common in the GTG than in the ITG. The follow-up time for the GTG was noticeably lower than that for the ITG.
Prednisone combined with MMF was effective for the treatment of IgAN with moderate-to-severe renal dysfunction.
免疫球蛋白A肾病（IgAN）是慢性肾小球肾炎的常见形式。目前，IgAN是中国慢性肾衰竭的主要病因之一；患者的预后差异很大，诊断时的肾功能与预后密切相关。霉酚酸酯（MMF）是一种具有良好免疫调节作用的药物，临床常用。然而，其在IgAN中的作用尚未得到明确证实。因此，在此我们回顾性比较了单独使用泼尼松或联合MMF治疗中度至重度肾功能损害的原发性IgAN的有效性和安全性。
评估泼尼松和MMF治疗中度至重度肾功能不全IgAN的有效性和安全性。
2011年1月至2020年12月，本研究纳入200例中度至重度IgAN患者，均入住南京医科大学附属无锡人民医院。所有患者均接受肾穿刺活检，结果显示为原发性IgAN，肾小球滤过率（GFR）为30 - 60 mL/min。根据不同治疗方案将患者分为糖皮质激素治疗组（GTG）和免疫抑制治疗组（ITG），每组100例。在进行如血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂等一般治疗的基础上，GTG组患者给予泼尼松0.5 - 0.8 mg/（kg·d），持续4 - 8周，每两周减少5 mg，直至达到维持剂量（30 mg/d）并维持12个月。在ITG组，给予MMF 1.0 g/d，持续6 - 个月，随后维持剂量为0.5 g/d，持续12个月。记录患者的年龄、性别、血压、24小时尿蛋白定量、血清肌酐（Scr）、血尿酸、血白蛋白、血钾（K）、血红蛋白、GFR、谷丙转氨酶、总胆固醇（T - CHO）、空腹血糖和体重指数。在治疗后3、6、9和12个月记录24小时尿蛋白、Scr和GFR水平。同时收集随访数据。
两组在入组时的年龄、性别、血压、肌酐、24小时尿蛋白水平、GFR或其他生化指标方面无明显差异。两种治疗方案均显著降低了24小时尿蛋白定量并稳定了肾功能。治疗9个月后，ITG组的24小时尿蛋白和Scr下降幅度比GTG组更显著。到治疗12个月时，两组的24小时尿蛋白和Scr与9个月时相比继续下降。此外，ITG组的总体缓解率显著高于GTG组。两种治疗方案的副作用发生率无显著差异；然而，GTG组的终点事件明显比ITG组更常见。GTG组的随访时间明显低于ITG组。
泼尼松联合MMF治疗中度至重度肾功能不全的IgAN有效。
