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Effect of steroid pulse therapy on post‐transplant immunoglobulin A nephropathy
Author(s) -
Matsukuma Yuta,
Masutani Kosuke,
Tsuchimoto Akihiro,
Okabe Yasuhiro,
Nakamura Masafumi,
Kitazono Takanari,
Tsuruya Kazuhiko
Publication year - 2018
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.13272
Subject(s) - medicine , proteinuria , renal function , creatinine , nephropathy , gastroenterology , urology , transplantation , adverse effect , prednisolone , kidney transplantation , surgery , kidney , endocrinology , diabetes mellitus
ABSTRACT Aim Recent studies have suggested that patients with post‐transplant immunoglobulin A nephropathy have poor graft survival. There is limited research on the therapeutic effectiveness for post‐transplant immunoglobulin A nephropathy, especially steroid pulse therapy. The present study evaluated the efficacy of steroid pulse therapy on post‐transplant immunoglobulin A nephropathy. Methods We retrospectively analyzed patients diagnosed with de novo or recurrent immunoglobulin A nephropathy at Kyushu University Hospital between January 2013 and August 2015. Patients with moderate proteinuria (≥0.5 g/g creatinine) and/or cellular or fibrocellular crescents on a graft biopsy were treated with steroid pulse therapy. Steroid pulse therapy was 500 mg/day for 3 days in weeks 1 and 2, followed by 20 mg of oral prednisolone that was tapered after 6 months. Patients were followed for 2 years, and the estimated glomerular filtration rate, urinary findings, and adverse events were recorded. Results Seven patients received steroid pulse therapy. The mean duration after kidney transplantation was 6.6 ± 4.7 years. After 2 years of treatment, 85.7% of patients reached complete remission of proteinuria, urinary protein excretion declined (0.82 ± 0.51 to 0.26 ± 0.22 g/g creatinine, P = 0.007), and the estimated glomerular filtration rate was maintained (48.7 ± 12.8 to 47.4 ± 14.0 mL/min per 1.73 m 2 , P = 0.98). Adverse events were observed in one patient who developed herpes zoster infection. Conclusion Steroid pulse therapy for post‐transplant immunoglobulin A nephropathy effectively reduces proteinuria over 2 years. However, comparison of steroid pulse therapy and other regimens with a high‐quality design is required.