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, yearsa
Type of treatment, %
RAS-I
Steroid
IS
Tonsillectomy
Reich et al. [6]
PR
<1.0
Whole follow-up
Prospective study
542
6.5 ± 4.9
53.0
12.5
15.7
ND
Le et al. [7]
PR
<0.5
Whole follow-up
Prospective study
1155
5.4 (4.1–7.2)
90.0
10.8
13.6
ND
Hotta et al. [9]
CR
<0.2b
Final observation
Retrospective study
329
6.9 ± 3.2
47.1
83.6c
28.9
76.0
Hwang et al. [11]
PR
<1.0
Within 2 years after starting anti-proteinuric treatment
Retrospective study
125
7.5 ± 3.3
100.0
20.0
14.4
ND
Hirano et al. [13]
PR
<0.4
One year after starting steroid pulse therapy
Retrospective study
141
3.8 (2.5–5.3)
44.0
100.0d
0.0
48.2
Tatematsu et al. [15]
CR
<0.2
Within 2 years of starting steroid pulse therapy
Retrospective study
109
3.3e
53.2
100.0d
0.0b
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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