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Long-term results of a randomized controlled trial in childhood IgA nephropathy
Koichi Kamei1, Koichi Nakanishi, Shuichi Ito
1Department of Nephrology, National Center for Child Health and Development, Setagaya, Tokyo, Japan.
Insights
Combination therapy significantly improved long-term kidney survival in children with severe IgA nephropathy. This treatment reduced the risk of end-stage renal failure (ESRF) in pediatric patients with diffuse mesangial proliferation.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Immunology
Background:
- IgA nephropathy (IgAN) with diffuse mesangial proliferation poses a high risk for end-stage renal failure (ESRF) in children.
- Previous studies indicated combination therapy may reduce renal injury and slow glomerular sclerosis progression.
Purpose of the Study:
- To evaluate the long-term effectiveness of a 2-year combination therapy regimen in children diagnosed with IgA nephropathy and diffuse mesangial proliferation.
- Assessing the impact of combination therapy on preventing the progression to ESRF.
Main Methods:
- Secondary analysis of a multicenter, randomized controlled trial.
- Involved 78 children with IgAN, comparing 2-year combination therapy versus control (heparin-warfarin and dipyridamole).
- Long-term follow-up with a median observation of 10 years.
Main Results:
- Combination therapy group had a lower incidence of ESRF (5%) compared to the control group (14.7%).
- Kaplan-Meier analysis showed significantly better renal survival in the combination therapy group (log-rank P = 0.03).
- The 10-year renal survival probability was 97.1% for combination therapy versus 84.8% for control therapy.
Conclusions:
- Two-year combination therapy effectively ameliorated acute nephritis activity in children with severe IgAN.
- This therapeutic approach significantly improved long-term renal outcomes, reducing the risk of ESRF in pediatric patients.
Background And Objectives:
Children with IgA nephropathy showing diffuse (>80%) mesangial proliferation are at high risk for end-stage renal failure (ESRF). A previous controlled trial showed that combination therapy consisting of prednisolone, azathioprine, heparin-warfarin, and dipyridamole early in the course of disease reduces immunologic renal injury and prevents the progression of sclerosed glomeruli. The objective of this study was to evaluate the long-term effectiveness of combination therapy in children with IgA nephropathy showing diffuse mesangial proliferation.
Design, Setting, Participants, & Measurements:
A secondary analysis of a multicenter, randomized, controlled trial involving 78 children with IgA nephropathy who received either 2-year combination therapy or heparin-warfarin and dipyridamole (control) therapy was conducted.
Results:
The median duration of observation was 10 years (range, 0.5 to 18). Two of 40 patients (5%) who received combination therapy and five of 34 patients (14.7%) who received control therapy developed ESRF. A Kaplan-Meier plot of renal survival showed that the outcomes of patients in the combined therapy group were better than those in the control therapy group (log-rank P = 0.03). The 10-year renal survival probability of each group was 97.1% (95% confidence interval, 81.4 to 99.6%) and 84.8% (95% confidence interval, 55.4 to 95.5%), respectively. The Cox proportional hazards model showed that the 2-year combination therapy was significantly associated with renal survival in both univariate and multivariate analyses.
Conclusions:
Two-year combination therapy not only ameliorated the activity of the acute phase of nephritis but also improved the long-term outcome of severe childhood IgA nephropathy.
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