Long-term Renal Prognosis of IgA Nephropathy with Therapeutic Trend Shifts
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概要
- 論文の詳細を見る
Objective We compared the effect of treatments in the long-term renal survival of IgA nephropathy. Methods One hundred and fourteen patients with biopsy-proven IgA nephropathy were retrospectively divided into 4 groups, reflecting shifts in treatment trends from 1985 to 2005: patients without treatment (no treatment group; n=36), patients treated only with anti-platelet drugs (anti-platelet group; n=12), those treated mainly with angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) (ACEI/ARB group; n =29), and prednisolone-treated patients (PSL group; n =37). Results Baseline blood pressure, serum creatinine and renal histological findings were similar among the 4 groups; however, the urinary protein level was significantly severer in the PSL group. After a mean follow-up of 7.0±0.5 years, end-stage renal disease occurred in 11 patients (31%) in the no treatment group, 5 patients (42%) in the anti-platelet group and 3 patients (8%) in the PSL group, but in only 1 patient (3%) in the ACEI/ARB group. Kaplan-Meier renal survival after 20 years was significantly better in the ACEI/ARB group than in the anti-platelet group or in the no treatment group (p<0.05). The patients that reached complete remission (CR) by steroid therapy showed less baseline urinary protein and milder histological lesions than those who did not reach CR. The non-CR group showed increases in serum creatinine and eGFR reduction rate. Conclusion Treatment with renin-angiotensin system inhibitors showed the greatest improvement of 20-year renal survival in IgA nephropathy patients. Steroid therapy achieved complete remission in some early-stage cases.
- 社団法人 日本内科学会の論文
著者
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Omata Masao
Department Of Cardiology Narita Red Cross Hospital
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Fujita Toshiro
Department Of Cardiovascular Medicine University Of Tokyo School Of Medicine
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Hirata Yasunobu
Department Of Advanced Clinical Science And Therapeutics Cardiovascular Medicine Graduate School Of
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GOTO Atsuo
Department of Internal Medicine, University of Tokyo
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Miyashita Kazuhisa
Department Of Clinical Research On Acupuncture Kansai College Of Oriental Medicine
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Tojo Akihiro
Department Of Internal Medicine University Of Tokyo
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Miyazaki Hiroki
Department Of Mechanical Engineering Kinki University
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Onozato Maristela
Department Of Nephrology And Endocrinology University Of Tokyo
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Kimura Kenjiro
Department Of Biochemistry National Cerebral And Cardiovascular Center Research Institute
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Kinugasa Satoshi
Department Of Nephrology Nippon Telegraph And Telephone Corporation (ntt) Kanto Medical Center
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Uehara Yoshio
Department Of General Medicine Kochi Medical School
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Fujita Toshiro
Department of Internal Medicine, University of Tokyo
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Tojo Akihiro
Department of Internal Medicine, University of Tokyo
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Asaba Kensuke
Department of Internal Medicine, University of Tokyo
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Goto Atsuo
Department of Gastroenterology, School of Medicine, University of Tokyo
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Miyazaki Hiroki
Department of Internal Medicine, University of Tokyo
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Uehara Yoshio
Department of Internal Medicine, University of Tokyo
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Kinugasa Satoshi
Department of Internal Medicine, University of Tokyo
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Onozato Maristela
Department of Internal Medicine, University of Tokyo
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Hirata Yasunobu
Department of Internal Medicine, University of Tokyo
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