The improvement of renal survival with steroid pulse therapy in IgA nephropathy.
The improvement of renal survival with steroid pulse therapy in IgA nephropathy.
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DOI：
10.1093/ndt/gfn394
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发表时间：
2008-12
影响因子：
6.1
通讯作者：
Hirakata, Hideki
中科院分区：
文献类型：
--
作者：
Katafuchi, Ritsuko;Ninomiya, Toshiharu;Mizumasa, Tohru;Ikeda, Kiyoshi;Kumagai, Harumitsu;Nagata, Masaharu;Hirakata, Hideki
背景资料。类固醇治疗免疫球蛋白A肾病(IgAN)的益处尚未确定。方法：研究方法。采用多因素分析方法，对702例IgA肾病患者激素治疗对肾脏存活的影响进行了回顾性研究。结果。共有295名男性和407名女性。中位随访时间为62个月。口服类固醇治疗194例(口服类固醇组)。34例患者先用甲基强的松龙(MPSL)冲击治疗(脉冲类固醇组)，然后口服强的松龙(PSL)。在474例患者中，未使用类固醇(未使用类固醇组)。治疗组间尿蛋白/肌酐比值和组织学分级有显着性差异，脉冲组最高，口服组次之，非激素组最低。脉搏类固醇组血清肌酐明显高于其他两组。85名患者发展为终末期肾功能衰竭(ESRF)，需要血液透析。在多变量分析中，类固醇脉冲治疗显著降低了终末期肾功能衰竭的风险，而口服类固醇治疗并未改善该队列中的肾脏存活率。结论。我们发现，脉冲类固醇治疗改善了IgAN患者的肾脏存活率。由于mPSL冲击治疗的患者临床表现和组织学分级最严重，因此这种治疗可能会阻止IgAN的进展。
Background. The benefits of steroid therapy in immunoglobulin A nephropathy (IgAN) have not been established. Methods. The effect of steroids on kidney survival was retrospectively investigated in 702 patients with IgAN by multivariate analyses. Results. There were 295 men and 407 women. The median follow-up period was 62 months. One hundred and ninety-four patients were treated with oral steroids (oral steroid group). Thirty-four patients were treated with methylprednisolone (mPSL) pulse therapy (pulse steroid group) followed by oral prednisolone (PSL). In 474 patients, no steroid was used (no steroid group). The urinary protein-creatinine ratio and histological grade were significantly different among treatment groups and were highest in the pulse steroid group followed by the oral steroid group and lowest in the no steroid patients. Serum creatinine was significantly higher in the pulse steroid group than in other two groups. Eighty-five patients developed end-stage renal failure (ESRF) requiring haemodialysis. In multivariate analysis, steroid pulse therapy significantly decreased the risk of ESRF while oral steroid treatment did not improve renal survival in this cohort. Conclusion. We found that pulse steroid therapy improved kidney survivals in IgAN. Since the clinical findings and histological grade were the most severe in patients treated with mPSL pulse therapy, such therapy may prevent progression of IgAN.
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影响因子：
2.5
作者：
KOBAYASHI, Y;HIKI, Y;TATENO, S
通讯作者：
TATENO, S
影响因子：
2.5
作者：
KOBAYASHI, Y;TATENO, S;SHIGEMATSU, H
通讯作者：
SHIGEMATSU, H
影响因子：
2.5
作者：
KOBAYASHI, Y;FUJII, K;KAMIYAMA, M
通讯作者：
KAMIYAMA, M
影响因子：
13.2
作者：
Katafuchi, R;Ikeda, K;Fujimi, S
通讯作者：
Fujimi, S
影响因子：
13.2
作者：
Shoji, T;Nakanishi, I;Tsubakihara, Y
通讯作者：
Tsubakihara, Y