Effect of Combined Treatment of Steroid and Angiotensin II Receptor Blocker (ARB) in Proteinuric IgA Nephropathy / 대한신장학회잡지

ABSTRACT

BACKGROUND: It has been reported that prednisolone (PDL) therapy favorably influences proteinuria and renal function in the patients with IgAN in whom ARB as well as ACE inhibitor has an anti- proteinuric effect. Therefore, we did a controlled prospective trial to test the effect of treatment with PDL (daily high-dose for 6 months) and ARB in proteinuric adult patients with IgAN. METHODS: Forty-two patients with proteinuria > or =1.0 g/day and serum Cr < or =2.0 mg/dL were randomized to treatment with PDL and ARB and to that with ARB alone. RESULTS: The follow-up period lasted 15.4+/-3.5 months in combination group (n=18) and 19.8+/-7.4 months in ARB group (n=20). Proteinuria was significantly reduced in the both groups (ARB group from 4.31+/-2.85 g to 1.38+/-1.09 g vs. combination group from 4.67+/-5.33g to 0.78+/-0.99 g). The rate of complete remission was 10% in ARB group and 44% in combination group at the final follow-up (p<0.05). There were no differences of mean serum Cr between groups before and after treatment. The number of patient with aggravation in renal function was five (25%) in ARB group and one (5%) in combination group. CONCLUSION: This study shows that the urinary protein excretion was effectively reduced by both groups and the rate of complete remission was higher in combination group than in ARB group. Long- term follow-up may be helpful to define the effect on the renal function in IgAN patients.