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Иммуносупрессия, тонзиллэктомия и ремиссии иммуноглобулин А-нефропатии высокого риска
Иммуносупрессия, тонзиллэктомия и ремиссии иммуноглобулин А-нефропатии высокого риска
Кочоян З.Ш., Лиева А.З., Гальковская Т.О., Добронравов В.А. Иммуносупрессия, тонзиллэктомия и ремиссии иммуноглобулин А-нефропатии высокого риска. Терапевтический архив. 2024;96(6):600–605. DOI: 10.26442/00403660.2024.06.202728
© ООО «КОНСИЛИУМ МЕДИКУМ», 2024 г.
DOI: 10.26442/00403660.2024.06.202728
© ООО «КОНСИЛИУМ МЕДИКУМ», 2024 г.
________________________________________________
DOI: 10.26442/00403660.2024.06.202728
Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Аннотация
Цель. Оценить эффективность иммуносупрессивной терапии (ИСТ) и тонзиллэктомии (ТЭ) у пациентов с иммуноглобулин A-нефропатией (IgAN) высокого риска.
Материалы и методы. Ретроспективная когорта исследования включала случаи с диагнозом первичной IgAN (n=213; возраст – 34±11 лет, мужчин – 52%) с высоким риском прогрессирования, с клиническими показателями и данными морфологических исследований. Период наблюдения составил 26 (10; 61) мес. Исследовали связь ИСТ без сочетания с ТЭ (ИСТ; n=141) или в сочетании с ТЭ (ИСТ+ТЭ; n=72) с развитием полной (ПР), частичной и общей (частичной или полной, ОР) ремиссий.
Результаты. Частота достижения ранних ПР или ОР в группах ИСТ и ИСТ+ТЭ составила 65,2 и 86,1% соответственно (p=0,002). Вероятность развития ранней ПР или ОР достоверно увеличивалась в группе ИСТ+ТЭ в сравнении ИСТ: отношение рисков 1,714 (1,214–2,420) и 3,410 (1,309–8,880) соответственно. ИСТ+ТЭ ассоциирована с 3–4-кратным увеличением вероятности ПР или ОР в конце наблюдения: отношение рисков 2,575 (1,679–3,950) и 4,768 (2,434–9,337) соответственно. Анализы с применением методов псевдорандомизации дали аналогичные результаты.
Заключение. ТЭ может быть эффективна для индукции ремиссии при IgAN высокого риска.
Ключевые слова: иммуноглобулин А-нефропатия, лечение, иммуносупрессия, тонзиллэктомия, ремиссии
Materials and мethods. The retrospective study cohort included cases with primary IgAN (n=213, age 34±11 years, male 52%) at high risk of progression with clinical and morphological data collected. The follow-up was 26 (10; 61) months. The association of IST without TE (IST; n=141) or with TE (IST+TE; n=72) with the development of complete (PR), partial (PR) and overall (PR or PR, OR) remissions was investigated.
Results. The incidence of achieving early PR or OR in the IST and IST+TE groups was 65.2% and 86.1%, respectively (p=0.002). The probability of early PR or OR was significantly increased in the IST+TE group compared to IST [HR 1.714 (1.214–2.420) and HR 3.410 (1.309–8.880), respectively]. IST+TE was associated with a 3- to 4-fold increase in the likelihood of PR or OR at the end of follow-up [HR 2.575 (1.679–3.950) and HR 4.768 (2.434–9.337), respectively]. Analyses using pseudorandomisation methods yielded similar results.
Conclusion. TE may be effective for remission induction in high-risk IgAN.
Keywords: immunoglobulin A nephropathy, treatment, immunosuppression, tonsillectomy, remissions
Материалы и методы. Ретроспективная когорта исследования включала случаи с диагнозом первичной IgAN (n=213; возраст – 34±11 лет, мужчин – 52%) с высоким риском прогрессирования, с клиническими показателями и данными морфологических исследований. Период наблюдения составил 26 (10; 61) мес. Исследовали связь ИСТ без сочетания с ТЭ (ИСТ; n=141) или в сочетании с ТЭ (ИСТ+ТЭ; n=72) с развитием полной (ПР), частичной и общей (частичной или полной, ОР) ремиссий.
Результаты. Частота достижения ранних ПР или ОР в группах ИСТ и ИСТ+ТЭ составила 65,2 и 86,1% соответственно (p=0,002). Вероятность развития ранней ПР или ОР достоверно увеличивалась в группе ИСТ+ТЭ в сравнении ИСТ: отношение рисков 1,714 (1,214–2,420) и 3,410 (1,309–8,880) соответственно. ИСТ+ТЭ ассоциирована с 3–4-кратным увеличением вероятности ПР или ОР в конце наблюдения: отношение рисков 2,575 (1,679–3,950) и 4,768 (2,434–9,337) соответственно. Анализы с применением методов псевдорандомизации дали аналогичные результаты.
Заключение. ТЭ может быть эффективна для индукции ремиссии при IgAN высокого риска.
Ключевые слова: иммуноглобулин А-нефропатия, лечение, иммуносупрессия, тонзиллэктомия, ремиссии
________________________________________________
Materials and мethods. The retrospective study cohort included cases with primary IgAN (n=213, age 34±11 years, male 52%) at high risk of progression with clinical and morphological data collected. The follow-up was 26 (10; 61) months. The association of IST without TE (IST; n=141) or with TE (IST+TE; n=72) with the development of complete (PR), partial (PR) and overall (PR or PR, OR) remissions was investigated.
Results. The incidence of achieving early PR or OR in the IST and IST+TE groups was 65.2% and 86.1%, respectively (p=0.002). The probability of early PR or OR was significantly increased in the IST+TE group compared to IST [HR 1.714 (1.214–2.420) and HR 3.410 (1.309–8.880), respectively]. IST+TE was associated with a 3- to 4-fold increase in the likelihood of PR or OR at the end of follow-up [HR 2.575 (1.679–3.950) and HR 4.768 (2.434–9.337), respectively]. Analyses using pseudorandomisation methods yielded similar results.
Conclusion. TE may be effective for remission induction in high-risk IgAN.
Keywords: immunoglobulin A nephropathy, treatment, immunosuppression, tonsillectomy, remissions
Полный текст
Список литературы
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2. Qian G, Zhang X, Xu W, et al. Efficacy and safety of glucocorticoids for patients with IgA nephropathy: A Meta-Analysis. Int Urol Nephrol. 2019;51(5):859-68.
DOI:10.1007/s11255-019-02094-5
3. Liu Y, Xiao J, Shi X, et al. Immunosuppressive Agents Versus Steroids in the Treatment of IgA Nephropathy-Induced Proteinuria: A Meta-Analysis. Exp Ther Med. 2016;11(1):49-56. DOI:10.3892/etm.2015.2860
4. Lee M, Suzuki H, Nihey Y, et al. Ethnicity and IgA nephropathy: worldwide differences in epidemiology, timing of diagnosis, clinical manifestations, management and prognosis. Clin Kidney J. 2023;16(Suppl. 2):ii1-8. DOI:10.1093/ckj/sfad199
5. Zhang H, Barratt J. Is IgA nephropathy the same disease in different parts of the world? Semin Immunopathol. 2021;43(5):707-15. DOI:10.1007/s00281-021-00884-7
6. Kidney Disease: Improving Global Outcomes Glomerular Diseases Work G. KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Kidney Int. 2021;100(4S):S115-27. DOI:10.1016/j.kint.2021.05.021
7. Duan J, Liu D, Duan G, Liu Z. Long term efficacy of tonsillectomy as a treatment in patients with IgA nephropathy: a meta-analysis. Int Urol Nephrol. 2017;49(1):103-12. DOI:10.1007/s11255-016-1432-7
8. Barbour SJ, Coppo R, Zhang H, et al. Evaluating a new international risk-prediction tool in IgA nephropathy. JAMA Intern Med. 2019;179:942-52. DOI:10.1001/jamainternmed.2019.0600
9. Добронравов В.А., Мужецкая Т.О., Лин Д.И., Кочоян З.Ш. Иммуноглобулин А-нефропатия в российской популяции: клинико-морфологическая презентация и отдаленный прогноз. Нефрология. 2019;6:45-60 [Dobronravov VA, Muzhetskaya TO, Lin DI, Kochoyan ZSh. Immunoglobulin A-nephropathy in Russian population: clinical and morphological presentation and long-term prognosis. Nephrology (Saint-Petersburg). 2019;23(6):45-60 (in Russian)]. DOI:10.36485/1561-6274-2019-23-6-45-60
10. Добронравов В.А., Кочоян З.Ш., Мужецкая Т.О., Лин Д.И. Анализ эффективности терапии иммуноглобулин А-нефропатии. Терапевтический архив.
2020;92(6):23-32 [Dobronravov VA, Kochoyan ZSh, Muzhetskaya TO, Lin DI. The analysis of treatment of Immunoglobulin A-nephropathy. Terapevticheskii Arkhiv (Ter. Arkh.). 2020;92(6):23-32 (in Russian)]. DOI:10.26442/00403660.2020.06.000669
11. Harabuchi Y, Takahara M. Recent advances in the immunological understanding of association between tonsil and immunoglobulin A nephropathy as a tonsil-induced autoimmune/inflammatory syndrome. Immun Inflamm Dis. 2019;7(2):86-93. DOI:10.1002/iid3.248
12. Liu LL, Wang LN, Jiang Y, et al. Tonsillectomy for IgA Nephropathy: a meta-analysis. Am J Kidney Dis. 2015;65(1):80-7. DOI:10.1053/j.ajkd.2014.06.036
13. Kovács T, Vas T, Kövesdy CP, et al. Effect of tonsillectomy and its timing on renal outcomes in Caucasian IgA nephropathy patients. Int Urol Nephrol. 2014;46(11):2175-82. DOI:10.1007/s11255-014-0818-7
14. Feehally J, Coppo R, Troyanov S. Tonsillectomy in a European Cohort of 1,147 Patients with IgA Nephropathy. Nephron. 2015;132(1):15-24. DOI:10.1159/000441852
15. Piccoli A, Codognotto M, Tabbi MG, et al. Influence of tonsillectomy on the progression of mesangioproliferative glomerulonephritis. Nephrol Dial Transplant. 2010;25(8):2583-9. DOI:10.1093/ndt/gfq107
16. Liu T, Wang Y, Mao H, et al. Efficacy and safety of immunosuppressive therapies in the treatment of high-risk IgA nephropathy: A network meta-analysis. Medicine (Baltimore). 2021;100(8):e24541. DOI:10.1097/MD.0000000000024541
17. Inker LA, Heerspink HJL, Tighiouart H, et al. Association of Treatment Effects on Early Change in Urine Protein and Treatment Effects on GFR Slope in IgA Nephropathy: An Individual Participant Meta-analysis. Am J Kidney Dis. 2021;78(3):340-9.e1. DOI:10.1053/j.ajkd.2021.03.007
18. Rauen T, Fitzner C, Eitner F, et al. Effects of Two Immunosuppressive Treatment Protocols for IgA Nephropathy. J Am Soc Nephrol. 2018;29:317-25. DOI:10.1681/ASN.2017060713
19. Tatematsu M, Yasuda Y, Morita Y, et al. Complete remission within 2 years predicts a good prognosis after methylprednisolone pulse therapy in patients with IgA nephropathy. Clin Exp Nephrol. 2012;16:883-91. DOI:10.1007/s10157-012-0644-0
20. Ochi A, Moriyama T, Takei T, et al. Comparison between steroid pulse therapy alone and in combination with tonsillectomy for IgA nephropathy. Int Urol Nephrol. 2013;45:469-76. DOI:10.1007/s11255-012-0251-8
21. Hou JH, Le WB, Chen N, et al. Mycophenolate Mofetil Combined With Prednisone Versus Full-Dose Prednisone in IgA Nephropathy With Active Proliferative Lesions: A Randomized Controlled Trial. Am J Kidney Dis. 2017;69:788-95. DOI:10.1053/j.ajkd.2016.11.027
22. Chen S, Qing Yin, Song Ren, et al. A comparison of the effectiveness of cyclophosphamide, leflunomide, corticosteroids, or conservative management alone in patients with IgA nephropathy: a retrospective observational study. Sci Rep. 2018;8:13663. DOI:10.1038/s41598-018-31727-5
23. Pozzi C, Andrulli S, Vecchio L, et al. Corticosteroid Effectiveness in IgA Nephropathy: Long-Term Results of a Randomized, Controlled Trial. J Am Soc Nephrol. 2004;15(1):157-63. DOI:10.1097/01.asn.0000103869.08096.4f
24. Zand L, Fervenza FC, Coppo R. Microscopic hematuria as a risk factor for IgAN progression: considering this biomarker in selecting and monitoring patients. Clin Kidney J.
2023 16(Suppl 2):ii19-27. DOI:10.1093/ckj/sfad232
25. Nagayama Y, Nishiwaki H, Hasegawa T, et al. Impact of the new risk stratification in the 2011 Japanese Society of Nephrology clinical guidelines for IgA nephropathy on incidence of early clinical remission with tonsillectomy plus steroid pulse therapy. Clin Exp Nephrol. 2015;19(4):646. DOI:10.1007/s10157-014-1052-4
2. Qian G, Zhang X, Xu W, et al. Efficacy and safety of glucocorticoids for patients with IgA nephropathy: A Meta-Analysis. Int Urol Nephrol. 2019;51(5):859-68.
DOI:10.1007/s11255-019-02094-5
3. Liu Y, Xiao J, Shi X, et al. Immunosuppressive Agents Versus Steroids in the Treatment of IgA Nephropathy-Induced Proteinuria: A Meta-Analysis. Exp Ther Med. 2016;11(1):49-56. DOI:10.3892/etm.2015.2860
4. Lee M, Suzuki H, Nihey Y, et al. Ethnicity and IgA nephropathy: worldwide differences in epidemiology, timing of diagnosis, clinical manifestations, management and prognosis. Clin Kidney J. 2023;16(Suppl. 2):ii1-8. DOI:10.1093/ckj/sfad199
5. Zhang H, Barratt J. Is IgA nephropathy the same disease in different parts of the world? Semin Immunopathol. 2021;43(5):707-15. DOI:10.1007/s00281-021-00884-7
6. Kidney Disease: Improving Global Outcomes Glomerular Diseases Work G. KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Kidney Int. 2021;100(4S):S115-27. DOI:10.1016/j.kint.2021.05.021
7. Duan J, Liu D, Duan G, Liu Z. Long term efficacy of tonsillectomy as a treatment in patients with IgA nephropathy: a meta-analysis. Int Urol Nephrol. 2017;49(1):103-12. DOI:10.1007/s11255-016-1432-7
8. Barbour SJ, Coppo R, Zhang H, et al. Evaluating a new international risk-prediction tool in IgA nephropathy. JAMA Intern Med. 2019;179:942-52. DOI:10.1001/jamainternmed.2019.0600
9. Dobronravov VA, Muzhetskaya TO, Lin DI, Kochoyan ZSh. Immunoglobulin A-nephropathy in Russian population: clinical and morphological presentation and long-term prognosis. Nephrology (Saint-Petersburg). 2019;23(6):45-60 (in Russian). DOI:10.36485/1561-6274-2019-23-6-45-60
10. Dobronravov VA, Kochoyan ZSh, Muzhetskaya TO, Lin DI. The analysis of treatment of Immunoglobulin A-nephropathy. Terapevticheskii Arkhiv (Ter. Arkh.). 2020;92(6):23-32 (in Russian). DOI:10.26442/00403660.2020.06.000669
11. Harabuchi Y, Takahara M. Recent advances in the immunological understanding of association between tonsil and immunoglobulin A nephropathy as a tonsil-induced autoimmune/inflammatory syndrome. Immun Inflamm Dis. 2019;7(2):86-93. DOI:10.1002/iid3.248
12. Liu LL, Wang LN, Jiang Y, et al. Tonsillectomy for IgA Nephropathy: a meta-analysis. Am J Kidney Dis. 2015;65(1):80-7. DOI:10.1053/j.ajkd.2014.06.036
13. Kovács T, Vas T, Kövesdy CP, et al. Effect of tonsillectomy and its timing on renal outcomes in Caucasian IgA nephropathy patients. Int Urol Nephrol. 2014;46(11):2175-82. DOI:10.1007/s11255-014-0818-7
14. Feehally J, Coppo R, Troyanov S. Tonsillectomy in a European Cohort of 1,147 Patients with IgA Nephropathy. Nephron. 2015;132(1):15-24. DOI:10.1159/000441852
15. Piccoli A, Codognotto M, Tabbi MG, et al. Influence of tonsillectomy on the progression of mesangioproliferative glomerulonephritis. Nephrol Dial Transplant. 2010;25(8):2583-9. DOI:10.1093/ndt/gfq107
16. Liu T, Wang Y, Mao H, et al. Efficacy and safety of immunosuppressive therapies in the treatment of high-risk IgA nephropathy: A network meta-analysis. Medicine (Baltimore). 2021;100(8):e24541. DOI:10.1097/MD.0000000000024541
17. Inker LA, Heerspink HJL, Tighiouart H, et al. Association of Treatment Effects on Early Change in Urine Protein and Treatment Effects on GFR Slope in IgA Nephropathy: An Individual Participant Meta-analysis. Am J Kidney Dis. 2021;78(3):340-9.e1. DOI:10.1053/j.ajkd.2021.03.007
18. Rauen T, Fitzner C, Eitner F, et al. Effects of Two Immunosuppressive Treatment Protocols for IgA Nephropathy. J Am Soc Nephrol. 2018;29:317-25. DOI:10.1681/ASN.2017060713
19. Tatematsu M, Yasuda Y, Morita Y, et al. Complete remission within 2 years predicts a good prognosis after methylprednisolone pulse therapy in patients with IgA nephropathy. Clin Exp Nephrol. 2012;16:883-91. DOI:10.1007/s10157-012-0644-0
20. Ochi A, Moriyama T, Takei T, et al. Comparison between steroid pulse therapy alone and in combination with tonsillectomy for IgA nephropathy. Int Urol Nephrol. 2013;45:469-76. DOI:10.1007/s11255-012-0251-8
21. Hou JH, Le WB, Chen N, et al. Mycophenolate Mofetil Combined With Prednisone Versus Full-Dose Prednisone in IgA Nephropathy With Active Proliferative Lesions: A Randomized Controlled Trial. Am J Kidney Dis. 2017;69:788-95. DOI:10.1053/j.ajkd.2016.11.027
22. Chen S, Qing Yin, Song Ren, et al. A comparison of the effectiveness of cyclophosphamide, leflunomide, corticosteroids, or conservative management alone in patients with IgA nephropathy: a retrospective observational study. Sci Rep. 2018;8:13663. DOI:10.1038/s41598-018-31727-5
23. Pozzi C, Andrulli S, Vecchio L, et al. Corticosteroid Effectiveness in IgA Nephropathy: Long-Term Results of a Randomized, Controlled Trial. J Am Soc Nephrol. 2004;15(1):157-63. DOI:10.1097/01.asn.0000103869.08096.4f
24. Zand L, Fervenza FC, Coppo R. Microscopic hematuria as a risk factor for IgAN progression: considering this biomarker in selecting and monitoring patients. Clin Kidney J.
2023 16(Suppl 2):ii19-27. DOI:10.1093/ckj/sfad232
25. Nagayama Y, Nishiwaki H, Hasegawa T, et al. Impact of the new risk stratification in the 2011 Japanese Society of Nephrology clinical guidelines for IgA nephropathy on incidence of early clinical remission with tonsillectomy plus steroid pulse therapy. Clin Exp Nephrol. 2015;19(4):646. DOI:10.1007/s10157-014-1052-4
2. Qian G, Zhang X, Xu W, et al. Efficacy and safety of glucocorticoids for patients with IgA nephropathy: A Meta-Analysis. Int Urol Nephrol. 2019;51(5):859-68.
DOI:10.1007/s11255-019-02094-5
3. Liu Y, Xiao J, Shi X, et al. Immunosuppressive Agents Versus Steroids in the Treatment of IgA Nephropathy-Induced Proteinuria: A Meta-Analysis. Exp Ther Med. 2016;11(1):49-56. DOI:10.3892/etm.2015.2860
4. Lee M, Suzuki H, Nihey Y, et al. Ethnicity and IgA nephropathy: worldwide differences in epidemiology, timing of diagnosis, clinical manifestations, management and prognosis. Clin Kidney J. 2023;16(Suppl. 2):ii1-8. DOI:10.1093/ckj/sfad199
5. Zhang H, Barratt J. Is IgA nephropathy the same disease in different parts of the world? Semin Immunopathol. 2021;43(5):707-15. DOI:10.1007/s00281-021-00884-7
6. Kidney Disease: Improving Global Outcomes Glomerular Diseases Work G. KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Kidney Int. 2021;100(4S):S115-27. DOI:10.1016/j.kint.2021.05.021
7. Duan J, Liu D, Duan G, Liu Z. Long term efficacy of tonsillectomy as a treatment in patients with IgA nephropathy: a meta-analysis. Int Urol Nephrol. 2017;49(1):103-12. DOI:10.1007/s11255-016-1432-7
8. Barbour SJ, Coppo R, Zhang H, et al. Evaluating a new international risk-prediction tool in IgA nephropathy. JAMA Intern Med. 2019;179:942-52. DOI:10.1001/jamainternmed.2019.0600
9. Добронравов В.А., Мужецкая Т.О., Лин Д.И., Кочоян З.Ш. Иммуноглобулин А-нефропатия в российской популяции: клинико-морфологическая презентация и отдаленный прогноз. Нефрология. 2019;6:45-60 [Dobronravov VA, Muzhetskaya TO, Lin DI, Kochoyan ZSh. Immunoglobulin A-nephropathy in Russian population: clinical and morphological presentation and long-term prognosis. Nephrology (Saint-Petersburg). 2019;23(6):45-60 (in Russian)]. DOI:10.36485/1561-6274-2019-23-6-45-60
10. Добронравов В.А., Кочоян З.Ш., Мужецкая Т.О., Лин Д.И. Анализ эффективности терапии иммуноглобулин А-нефропатии. Терапевтический архив.
2020;92(6):23-32 [Dobronravov VA, Kochoyan ZSh, Muzhetskaya TO, Lin DI. The analysis of treatment of Immunoglobulin A-nephropathy. Terapevticheskii Arkhiv (Ter. Arkh.). 2020;92(6):23-32 (in Russian)]. DOI:10.26442/00403660.2020.06.000669
11. Harabuchi Y, Takahara M. Recent advances in the immunological understanding of association between tonsil and immunoglobulin A nephropathy as a tonsil-induced autoimmune/inflammatory syndrome. Immun Inflamm Dis. 2019;7(2):86-93. DOI:10.1002/iid3.248
12. Liu LL, Wang LN, Jiang Y, et al. Tonsillectomy for IgA Nephropathy: a meta-analysis. Am J Kidney Dis. 2015;65(1):80-7. DOI:10.1053/j.ajkd.2014.06.036
13. Kovács T, Vas T, Kövesdy CP, et al. Effect of tonsillectomy and its timing on renal outcomes in Caucasian IgA nephropathy patients. Int Urol Nephrol. 2014;46(11):2175-82. DOI:10.1007/s11255-014-0818-7
14. Feehally J, Coppo R, Troyanov S. Tonsillectomy in a European Cohort of 1,147 Patients with IgA Nephropathy. Nephron. 2015;132(1):15-24. DOI:10.1159/000441852
15. Piccoli A, Codognotto M, Tabbi MG, et al. Influence of tonsillectomy on the progression of mesangioproliferative glomerulonephritis. Nephrol Dial Transplant. 2010;25(8):2583-9. DOI:10.1093/ndt/gfq107
16. Liu T, Wang Y, Mao H, et al. Efficacy and safety of immunosuppressive therapies in the treatment of high-risk IgA nephropathy: A network meta-analysis. Medicine (Baltimore). 2021;100(8):e24541. DOI:10.1097/MD.0000000000024541
17. Inker LA, Heerspink HJL, Tighiouart H, et al. Association of Treatment Effects on Early Change in Urine Protein and Treatment Effects on GFR Slope in IgA Nephropathy: An Individual Participant Meta-analysis. Am J Kidney Dis. 2021;78(3):340-9.e1. DOI:10.1053/j.ajkd.2021.03.007
18. Rauen T, Fitzner C, Eitner F, et al. Effects of Two Immunosuppressive Treatment Protocols for IgA Nephropathy. J Am Soc Nephrol. 2018;29:317-25. DOI:10.1681/ASN.2017060713
19. Tatematsu M, Yasuda Y, Morita Y, et al. Complete remission within 2 years predicts a good prognosis after methylprednisolone pulse therapy in patients with IgA nephropathy. Clin Exp Nephrol. 2012;16:883-91. DOI:10.1007/s10157-012-0644-0
20. Ochi A, Moriyama T, Takei T, et al. Comparison between steroid pulse therapy alone and in combination with tonsillectomy for IgA nephropathy. Int Urol Nephrol. 2013;45:469-76. DOI:10.1007/s11255-012-0251-8
21. Hou JH, Le WB, Chen N, et al. Mycophenolate Mofetil Combined With Prednisone Versus Full-Dose Prednisone in IgA Nephropathy With Active Proliferative Lesions: A Randomized Controlled Trial. Am J Kidney Dis. 2017;69:788-95. DOI:10.1053/j.ajkd.2016.11.027
22. Chen S, Qing Yin, Song Ren, et al. A comparison of the effectiveness of cyclophosphamide, leflunomide, corticosteroids, or conservative management alone in patients with IgA nephropathy: a retrospective observational study. Sci Rep. 2018;8:13663. DOI:10.1038/s41598-018-31727-5
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21. Hou JH, Le WB, Chen N, et al. Mycophenolate Mofetil Combined With Prednisone Versus Full-Dose Prednisone in IgA Nephropathy With Active Proliferative Lesions: A Randomized Controlled Trial. Am J Kidney Dis. 2017;69:788-95. DOI:10.1053/j.ajkd.2016.11.027
22. Chen S, Qing Yin, Song Ren, et al. A comparison of the effectiveness of cyclophosphamide, leflunomide, corticosteroids, or conservative management alone in patients with IgA nephropathy: a retrospective observational study. Sci Rep. 2018;8:13663. DOI:10.1038/s41598-018-31727-5
23. Pozzi C, Andrulli S, Vecchio L, et al. Corticosteroid Effectiveness in IgA Nephropathy: Long-Term Results of a Randomized, Controlled Trial. J Am Soc Nephrol. 2004;15(1):157-63. DOI:10.1097/01.asn.0000103869.08096.4f
24. Zand L, Fervenza FC, Coppo R. Microscopic hematuria as a risk factor for IgAN progression: considering this biomarker in selecting and monitoring patients. Clin Kidney J.
2023 16(Suppl 2):ii19-27. DOI:10.1093/ckj/sfad232
25. Nagayama Y, Nishiwaki H, Hasegawa T, et al. Impact of the new risk stratification in the 2011 Japanese Society of Nephrology clinical guidelines for IgA nephropathy on incidence of early clinical remission with tonsillectomy plus steroid pulse therapy. Clin Exp Nephrol. 2015;19(4):646. DOI:10.1007/s10157-014-1052-4
Авторы
З.Ш. Кочоян, А.З. Лиева, Т.О. Гальковская, В.А. Добронравов*
ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П. Павлова» Минздрава России, Санкт-Петербург, Россия
*dobronravov@nephrolog.ru
Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
*dobronravov@nephrolog.ru
ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П. Павлова» Минздрава России, Санкт-Петербург, Россия
*dobronravov@nephrolog.ru
________________________________________________
Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
*dobronravov@nephrolog.ru
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