Early treatment with corticosteroids ameliorates proteinuria, proliferative lesions, and mesangial phenotypic modulation in adult diffuse proliferative IgA nephropathy
Early treatment with corticosteroids ameliorates proteinuria, proliferative lesions, and mesangial phenotypic modulation in adult diffuse proliferative IgA nephropathy
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DOI：
10.1016/s0272-6386(00)70326-x
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发表时间：
2000-02-01
影响因子：
13.2
通讯作者：
Tsubakihara, Y
中科院分区：
文献类型：
--
作者：
Shoji, T;Nakanishi, I;Tsubakihara, Y
弥漫性增殖性免疫球蛋白A（伊加）肾病具有终末期肾病的潜在风险。然而，伊加肾病的治疗尚未得到很好的确立。为了确定早期皮质类固醇治疗是否能改善弥漫性增生性伊加肾病的增生性病变，我们进行了一项前瞻性、随机、对照试验。纳入标准如下：尿常规异常持续时间小于36个月，蛋白尿小于1.5 gld蛋白，血清肌酐水平小于1.5 mg/dL，肾小球系膜细胞增殖或基质积聚超过50%。21例患者随机分为两组：皮质类固醇组和抗血小板组。治疗1年后，19例患者再次进行肾活检。我们评估了肾小球滤过率、血压、蛋白尿和组织学参数，包括光镜检查结果和α-平滑肌肌动蛋白（α SMA）染色（作为成肌纤维细胞样细胞的标志物）和纤维连接蛋白EDA（EDA-FN）作为肾纤维化的指标。治疗1年后，皮质类固醇组的蛋白尿显著减少。组织学检查结果，如系膜细胞增殖，系膜基质积聚，细胞新月体，显示皮质类固醇组显着改善，但在抗血小板治疗组。皮质类固醇组肾小球中α-SMA的表达显着降低，但抗血小板组则无此变化。两组EDA-FN均无变化。我们的结论是，早期皮质类固醇治疗成人弥漫增生性伊加肾病是有效的，减少肾损伤。(C)2000年由国家肾脏基金会，公司。
Diffuse proliferative immunoglobulin A (IgA) nephropathy has the potential risk for end-stage renal disease. However, treatment of IgA nephropathy has not been well established. To determine whether early treatment with corticosteroids ameliorates the proliferative lesions of diffuse proliferative IgA nephropathy, we conducted a prospective, randomized, controlled trial. Inclusion criteria were as follows: duration of abnormal urinalysis results less than 36 months, proteinuria less than 1.5 gld of protein, serum creatinine level less than 1.5 mg/dL, and mesangial cell proliferation or matrix accumulation involving more than 50% of glomeruli, Twenty-one patients were randomly assigned to two groups: the corticosteroid group and the antiplatelet group. After 1 year of treatment, repeated renal biopsy was performed in 19 patients. We evaluated glomerular filtration rate, blood pressure, proteinuria, and histological parameters, including light microscopic findings and staining of alpha-smooth muscle actin (alpha SMA), as a marker of myofibroblast-like cells and fibronectin EDA (EDA-FN) as an indicator of renal fibrosis. After 1 year of treatment, proteinuria significantly decreased in the corticosteroid group. Histological findings, such as mesangial cell proliferation, mesangial matrix accumulation, and cellular crescents, showed significant improvement in the corticosteroid group but not in the antiplatelet group. Expression of alpha SMA in glomeruli significantly decreased in the corticosteroid group but not in the antiplatelet group. EDA-FN did not change in either group. We conclude that early treatment with corticosteroids for adult diffuse proliferative IgA nephropathy is effective in reducing renal injury. (C) 2000 by the National Kidney Foundation, Inc.