Treatment of Iga nephropathy in children : efficacy of alternate-day oral prednisone

We have previously reported our experience with the use of alternate-day prednisone in the treatment of 6 patients with IgA nephropathy who have clinical or pathological risk factors for disease progression. We have now treated a total of 13 patients and followed them from 4 to 10 years. Patients re...

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Published in:Pediatric nephrology (Berlin, West) West), 1993-10, Vol.7 (5), p.529-532
Main Authors: WALDO, F. B, WYATT, R. J, KELLY, D. R, HERRERA, G. A, BENFIELD, M. R, KOHAUT, E. C
Format: Article
Language:English
Subjects:
Administration, Oral
Adolescent
Biological and medical sciences
Child
Drug Administration Schedule
Female
Follow-Up Studies
Glomerular Filtration Rate
Glomerulonephritis, IGA - drug therapy
Glomerulonephritis, IGA - urine
Humans
Immunomodulators
Longitudinal Studies
Male
Medical sciences
Pharmacology. Drug treatments
Prednisone - therapeutic use
Proteinuria - urine
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Summary:We have previously reported our experience with the use of alternate-day prednisone in the treatment of 6 patients with IgA nephropathy who have clinical or pathological risk factors for disease progression. We have now treated a total of 13 patients and followed them from 4 to 10 years. Patients received an alternate-morning dose of prednisone for 2-4 years. Dosage began at 60 mg/m2 for 3 month, was reduced to 30 mg/m2 by 1 year and 15 mg/m2 by 2 years. At last observation, urinary protein excretion was normal in 12 patients and no patient had hematuria. Twelve patients had normal estimated glomerular filtration rate (GFR) and one had renal insufficiency (GFR = 38 ml/min per 1.73 m2). A renal biopsy was performed in 11 patients after 2 years of treatment. Activity score decreased from 5.2 to 4.3 (P = 0.03) and chronicity score increased from 2.2 to 2.8 (P = 0.12). There were no complications of treatment. When compared with a historical group, the treated patients had a significant improvement in urinalysis (P < 0.00001) and preservation of normal GFR (P = 0.03). We conclude that alternate-day prednisone therapy may benefit patients with IgA nephropathy. A large prospective controlled trial is needed.
ISSN:0931-041X
1432-198X
DOI:10.1007/bf00852535