Korean Journal of Nephrology 2010;29(1):38-45.
Combined Therapy of Cyclophosphamide and Steroid on Progressive IgA Nephropathy
Sung-yeon Cho, M.D., So-young Choi, M.D., Dong-young Lee, M.D., Ju-young Moon, M.D. Kyung-hwan Jung, M.D., Sang-ho Lee, M.D., Tae-won Lee, M.D. and Chun-kyu Lim, M.D.
Division of Nephrology, Department of Internal Medicine Kyung hee University College of Medicine, Seoul Korea
원저 : 진행성 IgA 신증 환자에서 사이클로포스파마이드와 스테로이드의 병합요법
조성연, 최소영, 이동영, 문주영, 정경환, 이상호, 이태원, 임천규
경희대학교 의과대학 신장내과학교실
Abstract
Purpose : There were several reports showing that combined therapy of steroid and cyclophosphamide (PSL+CPA) was effective on progressive IgA nephropathy, but it remains inconclusive. Methods : Patients with IgA nephropathy who showed more than 1.5 mg/dL of serum creatinine (SCr) and proteinuria and who were treated with the combined therapy in the Kyung hee University Hospital. Results : The subjects were fifteen patients whose age was 40.3±10.8 yr, and the follow-up period was 39.1±24.6 months. Proteinuria levels declined from 4.08±2.58 g/gCr baseline to 1.80±1.72 g/ gCr 6 months after the treatment (p<0.0001). The comparison between the levels before & 6 months after the ΔeGFR showed the improvement from -1.16±6.29 mL/min/1.73m2/month to 0.84±1.63 mL/ min/1.73m2/month (p=0.21), while these differences did not reach the level of statistical ignificance. According to ΔeGFR, when the subjects were divided into the responder group (8 patients) and the non-responder group (7 patients), the former was 1.69±1.88 mL/min/1.73m2/month and the latter was -0.14±0.15 mL/min/1.73m2/month with significant difference (p=0.0014). According to UPCR, the responder group (12 patients) and the non-responder group (3 patients), systolic pressure, glomerulosclerosis and proteinuria after 6 months were significantly different (p=0.0115). Also, according to progressing ESRD, the CKD group (7 patients) and ESRD group (8 patients), age and SCr have shown a significant difference (p=0.0064). Conclusion : The combined therapy on progressive IgA nephropathy effectively reduced proteinuria and had protective effects on renal function in some patients. However, proteinuria and others were insufficient to be predictive factors on therapeutic responses. Large-scale prospective controlled studies may be necessary in the future.
Key Words: Cyclophosphamide, Steroid, IgA nephropathy


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