Cyclosporine A combined with medium/low dose prednisone in progressive IgA nephropathy

The aim of the present study was to evaluate the efficacy of cyclosporine A (CsA) combined with medium/low dose prednisone in the treatment of progressive immunoglobulin A nephropathy (IgAN). Ninety-six patients who satisfied the inclusion criteria were enrolled in a prospective controlled clinical study. They were assigned into two groups and initially given either 0.6-0.8 mg/kg/day prednisone (maximum 40 mg/day) plus 3 mg/kg/day CsA (CsA group), or 1 mg/kg/day prednisone (maximum 60 mg/day) alone (steroid group). During therapy, the dose of prednisone was reduced in both groups and the dose of CsA was gradually tailed off over the first 3 months and maintained at 2 mg/kg/day in the CsA group. Urinary protein excretion, serum biochemical indexes, clinical efficacy and side effects of CsA were assayed. A significant decline in mean 24-hour urinary protein excretion (p < 0.05) was observed 1 month after treatment in patients in the CsA group, which was observed 2 months after treatment in the steroid group. The decline in mean 24-hour urinary protein excretion in the CsA group was more significant than in the steroid group. Serum albumin level increased significantly in the CsA group 2 months after therapy (p < 0.05). Moreover, at the end of the course, a higher remission rate was observed in patients with Lee's Grade III IgAN after combined treatment with prednisone and CsA (p < 0.05). No significant difference in clinical efficacy was observed in patients with Lee's Grade IV and Grade V IgAN between the two groups (p > 0.05). CsA at a dose of 2-3 mg/kg/day in combination with medium/low dose prednisone was effective in inducing remission of IgAN, especially for patients with Lee's Grade III IgAN, and is a safe and effective choice for short-term treatment of patients with progressive IgAN.