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Combined Therapy with Azathioprine, Prednisone, and Enalapril in Children with IgAN and IgAVN

Małgorzata Mizerska-Wasiak1, Miłosz Starczyński2, Wojciech Wasiak2

  • 1Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland.

Journal of Clinical Medicine
|December 17, 2024
PubMed

Insights

Combined immunosuppressive therapy (azathioprine, prednisone, enalapril) significantly reduced proteinuria and hematuria in children with IgAN and IgAVN compared to enalapril alone.

Area of Science:

  • Pediatric Nephrology
  • Immunology
  • Glomerular Diseases

Background:

  • IgA nephropathy (IgAN) and IgA vasculitis nephritis (IgAVN) are common causes of glomerular disease in children.
  • Kidney biopsy with Oxford classification is crucial for diagnosis and prognosis.
  • Evaluating effective treatment strategies for pediatric IgAN and IgAVN is essential.

Purpose of the Study:

  • To assess the efficacy of a 1-year combined immunosuppressive treatment (azathioprine, prednisone, enalapril) versus enalapril monotherapy in children with IgAN and IgAVN.
  • To evaluate treatment effects on proteinuria, hematuria, and kidney biopsy findings.

Main Methods:

  • A cohort of 68 children diagnosed with IgAN or IgAVN via kidney biopsy were included.
  • The study group (36 children) received azathioprine, prednisone, and enalapril (AZA+PRED+E) with control biopsies.
  • The control group (32 children) received enalapril alone for one year post-biopsy.

Main Results:

  • Combined AZA+PRED+E therapy led to significant reductions in proteinuria and hematuria after 1 year.
  • The reduction in proteinuria was significantly greater in the AZA+PRED+E group compared to the enalapril-only group (p=0.015 for IgAN, p=0.008 for IgAVN).
  • Improvement in Oxford classification scores (E and T lesions) was frequently observed in the AZA+PRED+E treated group.

Conclusions:

  • Combined immunosuppressive therapy (AZA+PRED+E) is effective in managing proteinuria and hematuria in pediatric IgAN and IgAVN.
  • Children with higher proteinuria and MESTC scores may benefit from personalized immunosuppressive treatment plans.
  • This approach offers a potential personalized treatment strategy for children with these kidney diseases.

Keywords:
IgANIgAVNazathioprinecombined treatmentenalaprilprednisone

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