Predictors of response in patients with progressive IgA nephropathy treated with leflunomide and medium/low-dose corticosteroid
10.3760/cma.j.issn.1001-7097.2018.07.002
- VernacularTitle:来氟米特联合中小剂量激素治疗进展性IgA肾病的疗效预测
- Author:
Lulin MIN
1
;
Qin WANG
;
Huihua PANG
;
Minfang ZHANG
;
Xiajing CHE
;
Liou CAO
;
Shan MOU
;
Leyi GU
;
Wei FANG
;
Renhua LU
;
Mingli ZHU
;
Ling WANG
;
Zanzhe YU
;
Wenyan ZHOU
;
Zhenyuan LI
;
Jiaqi QIAN
;
Zhaohui NI
Author Information
1. 200127,上海交通大学医学院附属仁济医院肾脏科
- Keywords:
Glomerulonephritis,IGA;
Immunosuppressive agents;
Glucocorticoids;
Relapse;
Leflunomide
- From:
Chinese Journal of Nephrology
2018;34(7):488-493
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the factors affecting the efficacy of leflunomide combined with medium/low dose corticosteroids in the treatment of progressive IgA nephropathy (IgAN).Methods Clinical and pathological parameters were collected retrospectively in patients of primary IgAN with proteinuria＞ 1.0 g/24 h and chronic kidney disease (CKD) stage 1-3 treated with leflunomide combined with medium/low dose corticosteroids in Ren Ji Hospital,School of Medicine,Shanghai Jiao Tong University from Jan 2005 to Dec 2010.According to the treatment effects,patients were divided into complete remission group and non-complete remission group.The biochemical and pathological indexes of the two groups were compared.Results A total of 42 patients were included.The remission rates at 3,6,9 and 12 months were 62％,64％,67％ and 74％,respectively.Seventeen (40.5％) and fourteen (33.3％) patients achieved complete and partial remission after one-year treatment,and the remission rate remained stable within one year after withdrawal of drugs.The 24hour proteinuria was 1.50 (0.67,2.66) g,which was significantly reduced compared with the baseline 2.44 (1.36,3.74) g (P ＜ 0.01).The decrease rate was 31.3％.There was a slight decrease in proteinuriawithin one year after withdrawal of drugs.Estimated glomerular filtration rate (eGFR) remained stable during the treatment and a year of follow-up.No serious adverse event was observed during the followup period.Among 31 responder patients,6(19.4％) patients relapsed.Logistic multivariate regression analysis suggested that the degree of renal interstitial inflammatory infiltration was an independent predictor of complete remission with one-year treatment of leflunomide combined with medium / low dose corticosteroids (HR=0.067,95％ CI 0.008-0.535,P=0.011).Conclusions IgAN treated with leflunomide and medium/low dose corticosteroids can achieve remission in early stage,and the remission rate remains stable after withdrawal of drugs.It is a safe option for the treatment of IgAN.Renal interstitial inflammatory infiltration is an independent predictor of complete remission.
