What Is the Goal for Proteinuria in IgA Nephropathy?

Published on 01/05/2016 by admin

Filed under Nephrology

Last modified 03/05/2016

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Authors

Proposed target proteinuria

Study design and characteristics of the cohort

Partial remission or clinical remission

Definition of proteinuria remission, g/day

Timing of proteinuria measurements taken as a surrogate marker

Prospective or retrospective study design

Number of patients

Follow-up, years^a

Type of treatment, %

RAS-I

Steroid

Tonsillectomy

Reich et al. [6]

<1.0

Whole follow-up

Prospective study

542

6.5 ± 4.9

53.0

12.5

15.7

Le et al. [7]

<0.5

Whole follow-up

Prospective study

1155

5.4 (4.1–7.2)

90.0

10.8

13.6

Hotta et al. [9]

<0.2^b

Final observation

Retrospective study

329

6.9 ± 3.2

47.1

83.6^c

28.9

76.0

Hwang et al. [11]

<1.0

Within 2 years after starting anti-proteinuric treatment

Retrospective study

125

7.5 ± 3.3

100.0

20.0

14.4

Hirano et al. [13]

<0.4

One year after starting steroid pulse therapy

Retrospective study

141

3.8 (2.5–5.3)

44.0

100.0^d

0.0

48.2

Tatematsu et al. [15]

<0.2

Within 2 years of starting steroid pulse therapy

Retrospective study

109

3.3^e

53.2

100.0^d

0.0^b

49.5

RAS-I renin angiotensin aldosterone system inhibitors, IS any immunosuppresion, PR partial remission, CR clinical remission defined by absence of proteinuria and hematuria, ND not determined

^aValues are presented as mean ± standard deviation or median (interquartile range)

^bAuthor’s speculation

^cIt included 59.9 % of steroid pulse therapy and 23.7 % as conventional steroid therapy

^dSteroid pulse therapy by Pozzi’s regimen

^eShown as median and its range was from 0.7 to 9.4

17.3 Previous Proposal of Clinical Remission Defined by the Absence of Proteinuria and Hematuria at Final Observation as Treatment Goal

Kobayashi et al. reported effectiveness of steroids for IgA nephropathy in 1988 [8]. At that time, oral steroids were the mainstay of treatment, and less than 1.0 g/day was commonly accepted as target proteinuria. With advances in treatment, target proteinuria may undergo a paradigm shift. In 2001, Hotta et al. proposed the concept of clinical remission defined by complete disappearance of proteinuria and hematuria at final observation as opposed to partial remission, as the treatment goal [9]. They reported an observational study composed by 329 cases of IgA nephropathy with a mean observation period of 6.9 years (Table 17.1

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