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Sequential immunosuppressive therapy in progressive IgA nephropathy.

Franz Maximilian Rasche1, Frieder Keller, Lutz von Müller

  • 1Division of Nephrology, Department of Internal Medicine I, University Hospital of Ulm, Ulm, Germany. maximilian.rasche@uniklinik-ulm.de

Contributions to Nephrology
|May 15, 2007
PubMed
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Sequential therapy with cyclophosphamide pulses (CyP) and mycophenolic acid (MPA) can slow kidney function decline and reduce proteinuria in IgA nephropathy (IgAN) patients, even those with advanced disease.

Area of Science:

  • Nephrology
  • Immunology
  • Internal Medicine

Background:

  • IgA nephropathy (IgAN) is a progressive kidney disease.
  • Cyclophosphamide and high-dose steroids are used as induction therapy.
  • Their efficacy in slowing renal function loss and proteinuria is limited in advanced stages.

Purpose of the Study:

  • To evaluate the effect of sequential cyclophosphamide pulses (CyP) and mycophenolic acid (MPA) therapy.
  • To assess impact on renal function in patients with progressive IgAN.
  • To determine efficacy in patients with advanced renal failure.

Main Methods:

  • Twenty patients with progressive IgAN and advanced renal failure were studied.
  • Patients received sequential therapy with CyP followed by MPA (mycophenolate mofetil 1g/day).

Related Experiment Videos

  • Treatment duration was a median of 27 months.

    • Main Results:

    • Monthly loss of renal function significantly reduced from -2.4 ml/min to -0.12 ml/min (p=0.0009).
    • Estimated renal survival time significantly prolonged by 65 months (p=0.0014).
    • Proteinuria decreased significantly from 1.7 to 0.4 g/l (p=0.015).

    Conclusions:

    • Sequential CyP/MPA therapy can arrest or slow renal function loss in progressive IgAN.
    • This therapy effectively reduces proteinuria.
    • It offers a potential treatment option even for patients past the 'point of no return'.