caa a22 4500 445882417 CHVBK 20180317145547.0 cr unu---uuuuu 170323e20110201xx s 000 0 eng 10.1007/s10157-010-0356-2 doi (NATIONALLICENCE)springer-10.1007/s10157-010-0356-2 Methylprednisolone pulse therapy combined with mizoribine following tonsillectomy for immunoglobulin A nephropathy: clinical remission rate, steroid sparing effect, and maintenance of renal function [Elektronische Daten] [Tomohiro Kaneko, Akio Hirama, Kae Ueda, Teppei Fujino, Koichi Utsumi, Yasuhiko Iino, Yasuo Katayama] Background: The long-term prognosis of immunoglobulin A nephropathy (IgAN) is reportedly poor. In Japan, tonsillectomy-steroid pulse therapy has frequently been used for treatment of early IgAN, with favorable outcomes. However, steroid usage is sometimes limited due to adverse reactions. To reduce the total dose of steroids, we have been using mizoribine (MZR) in combination with tonsillectomy-steroid pulse therapy since 2004. Here we report a retrospective evaluation of our protocol outcome. Methods: Forty-two patients aged <70years with histopathologically confirmed IgAN and an estimated glomerular filtration rate (eGFR) of 30ml/min/1.73m2 or higher were enrolled. After giving informed consent, all the patients underwent bilateral tonsillectomy. One week later, intravenous methylprednisolone pulse therapy (500mg/day) was administered for 3days, followed by oral prednisolone (30mg/day and tapered to 0 over 7months) and MZR (150mg/day for 11months). The complete remission (CR) rate and renoprotective effect were assessed. Results: The CR rate at 6, 12, and 24months was 33.3, 69.1, and 76.2%, respectively. Despite a relatively low total steroid dose, renal function was satisfactorily maintained for 24months or longer with no relapse. The eGFR in patients with stage 3 chronic kidney disease was significantly improved at 6months after start of treatment. Three patients (7.1%) had mild and transient adverse events. Conclusion: This protocol appears to be highly effective and safe for IgAN patients with renal dysfunction. Japanese Society of Nephrology, 2010 Clinical remission nationallicence IgA nephropathy nationallicence Methylprednisolone pulse nationallicence Mizoribine nationallicence Steroid sparing effect nationallicence Tonsillectomy nationallicence Kaneko Tomohiro Divisions of Neurology, Nephrology and Rheumatology, Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, 113-8603, Tokyo, Japan aut Hirama Akio Divisions of Neurology, Nephrology and Rheumatology, Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, 113-8603, Tokyo, Japan aut Ueda Kae Divisions of Neurology, Nephrology and Rheumatology, Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, 113-8603, Tokyo, Japan aut Fujino Teppei Divisions of Neurology, Nephrology and Rheumatology, Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, 113-8603, Tokyo, Japan aut Utsumi Koichi Divisions of Neurology, Nephrology and Rheumatology, Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, 113-8603, Tokyo, Japan aut Iino Yasuhiko Divisions of Neurology, Nephrology and Rheumatology, Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, 113-8603, Tokyo, Japan aut Katayama Yasuo Divisions of Neurology, Nephrology and Rheumatology, Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, 113-8603, Tokyo, Japan aut Clinical and Experimental Nephrology Springer Japan 15/1(2011-02-01), 73-78 1342-1751 15:1<73 2011 15 10157 https://doi.org/10.1007/s10157-010-0356-2 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s10157-010-0356-2 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Kaneko Tomohiro Divisions of Neurology, Nephrology and Rheumatology, Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, 113-8603, Tokyo, Japan aut NATIONALLICENCE 700 1- Hirama Akio Divisions of Neurology, Nephrology and Rheumatology, Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, 113-8603, Tokyo, Japan aut NATIONALLICENCE 700 1- Ueda Kae Divisions of Neurology, Nephrology and Rheumatology, Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, 113-8603, Tokyo, Japan aut NATIONALLICENCE 700 1- Fujino Teppei Divisions of Neurology, Nephrology and Rheumatology, Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, 113-8603, Tokyo, Japan aut NATIONALLICENCE 700 1- Utsumi Koichi Divisions of Neurology, Nephrology and Rheumatology, Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, 113-8603, Tokyo, Japan aut NATIONALLICENCE 700 1- Iino Yasuhiko Divisions of Neurology, Nephrology and Rheumatology, Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, 113-8603, Tokyo, Japan aut NATIONALLICENCE 700 1- Katayama Yasuo Divisions of Neurology, Nephrology and Rheumatology, Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, 113-8603, Tokyo, Japan aut NATIONALLICENCE 773 0- Clinical and Experimental Nephrology Springer Japan 15/1(2011-02-01), 73-78 1342-1751 15:1<73 2011 15 10157 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer