The Comparison Between Prednisone And Cyclophosphamide In Treatment To IgA Nephropathy

Objective:Immunoglobin A nephropathy(Ig AN)is the most commonly primary glomerulonephritis in China.However,there are still 20-40% of the patients reach end-stage renal disease despite positive treatment.There is still controversial about the efficacy of Ig AN treatment between Glucocorticoid(P)and cyclophosphamide(CTX).In this study,patients with Ig AN in our center(Department of Nephrology,Sichuan Provincial People's Hospital)were selected to investigate the effect of glucocorticoid,glucocorticoid combined with cyclophosphamide on the efficacy and safety of Ig AN.Methods:This study collected patients in Sichuan Provincial People's Hospital from January 1,2006 to June 30,2016.And the patients were diagnosed to be Ig AN by renal biopsy.To analyze the baseline of clinical manifestation,data about pathology,initial treatment,the changes of renal function,proteinuria and adverse events during follow-up were collected.236 cases were selectedwho received RASI,RASI+P or P+CTX treatment and be followed up over 6months.Results : 236 patients were divided into RASI,P +RASI,P+ CTX three treatment groups.RASI group included 71 cases.P+RASI group had 80 cases.And P+CTX group included 85 cases.There were no among three groups about The baseline including age,blood pressure and course of disease.Among them,the 24 hours urine protein of P+CTX group was higher than the other two groups(1.5(0.9-2.5)vs.1.06(0.05-2.3)vs.1.2(0.9-2.6)g/d,p=0.001).The e GFR of P+CTX group was lower than the other two groups(64.7±35.3 vs.91.2±33.4 vs.89.3±30.5ml/min/1.73m2,p=1.70×10-8).Renal biopsy resultsshowed thatrenal injury in P+CTX group was the most serious.Proliferationof mesangial cells,loopnecrosis,segmentalsclerosis,glomerulosclerosis and renal tubular atrophy or interstitial fibrosis,inflammatory cell infiltration and vascular lesions were more frequently existed in P+ CTX group(p<0.05).The follow-up result of three groups showed that urinary protein was significantly decreased in P+CTX group(p<0.05).P+CTX group increased the most significantly in e GFR.Compared with the renal survival rate of three groups,RASI group and RASI+P group excelled than P+CTX group by Kaplan-Meier survival curve analysis(p<0.05).Defined as the end event with 30% reduction of e GFR baseline,the survival rate of RASI+P or RASI group was significantly decreased,P+CTX group was higher than that of RASI group(p>0.05).RASI+P was similar to P+CTX group with adverse reactions(p>0.05).Conclusions:RASI,RASI+P and P+CTX could significantly reduce the proteinuria of Ig A nephropathy and delay the progression of renal function.Glucocorticoid is effective and safe for patients with Ig AN.Glucocorticoid combined with cyclophosphamide in the treatment of Ig AN patients with severe renal lesions showed good efficacy and safety.