| Retrospective Comparisons about Effects of Angiotensin II Receptor Blocker and/or Steroid on Proteinuria Reduction and Renal Protection in IgA Nephropathy Patients with Proteinuria less than 1 g/g |
| Seung-Joon Hwang, M.D., So Young Choi, M.D., Sung Yeon Cho, M.D., Ji Young Park, M.D., Kyung-Hwan Jung, M.D., Joo-Yung Moon, M.D., Sang Ho Lee, M.D., Tae Won Lee, M.D. and Chun Gyoo Ihm, M.D. |
| Division of Nephrology, Department of Internal Medicine, College of Medicine Kyung Hee University, Seoul, Korea |
| 원저 : 요 단백 크레아티닌 비가 1 g/g 이하인 IgA 신증 환자들에서 안지오텐신 II 수용체 길항제 또는 스테로이드의 단독 및 병합 치료 효과의 후향적 비교 |
| 황승준, 최소영, 조성연, 박지영, 정경환, 문주영, 이상호, 이태원, 임천규 |
| 경희대학교 의과대학 신장내과학교실 |
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| Abstract |
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Purpose:It remains controversial how to treat the IgA nephropathy (IgAN) patients with proteinuria <1 g/day. We investigated effects of single or combined use of angiotensin II receptor blocker (ARB) and steroid on proteinuria reduction and renal protection in IgAN patients with normal renal function and urine protein/creatinine ratio (PCR) ≤1 g/g.
Methods:Oral prednisolone was given at an initial dose of 1 mg/kg every day for 2 months and then gradually tapered for 4 months. An ARB irbesartan or losartan or valsartan was given until the end of follow-up.
Results:Over a mean follow-up period of about 40 mo, the urine PCR decreased from 0.64±0.29 g/g to 0.32±0.31 g/g in the combination group (n=26) (p<0.05). But in ARB (n=17) and steroid groups (n=20), it decreased from 0.56±0.26 g/g to 0.54±0.45 g/g and from 0.50±0.26 g/g to 0.34±0.32 g/g, respectively, while there were no statistical significances. Serum creatinine decreased from 0.83±0.13 mg/dL to 0.73±0.14 mg/dL in steroid group (p<0.01), and from 0.92±0.17 mg/dL to 0.81±0.23 mg/dL in combination group (p<0.01). But in ARB group, no statistical significance was noticed. All patients achieved the BP goal ≤130/80 mmHg by adding anti-hypertensive drugs, if necessary.
Conclusion:Our results indicate that (steroid or) combination therapy reduced proteinuria and improved renal function in the patients with proteinuria ≤1 g/g. Further prospective controlled studies are required to clarify the effect of steroid over the long term. |
| Key Words:
Glomerulonephritis, IgA, Angiotensin II type 1 receptor blockers, Prednisolone, Proteinuria |
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