Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 16, 2023; 11(35): 8300-8309
Published online Dec 16, 2023. doi: 10.12998/wjcc.v11.i35.8300
Efficacy of prednisone combined with mycophenolate mofetil for immunoglobulin A nephropathy with moderate-to-severe renal dysfunction
Mei-Juan Meng, Ling Hu, Yun Fan, Han Gao, Han-Zhi Chen, Cai-Mei Chen, Zhen Qi, Bin Liu
Mei-Juan Meng, Ling Hu, Yun Fan, Han Gao, Han-Zhi Chen, Cai-Mei Chen, Zhen Qi, Bin Liu, Department of Nephrology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi 214023, Jiangsu Province, China
Author contributions: Meng MJ, Hu L, and Fan Y contributed equally to this work and are co-first authors; Meng MJ contributed to methodology; Hu L contributed to data curation; Fan Y contributed to visualization; Gao H contributed to data curation; Chen HZ, Chen CM, and Qi Z contributed to resources and validation; Liu B contributed to funding acquisition; Meng MJ, Hu L, Fan Y, and Liu B contributed to conceptualization; Hu L and Fan Y contributed to investigation; Meng MJ, Hu L, and Fan Y contributed to writing-original draft, writing - review and editing; Meng MJ and Liu B contributed to project administration; Hu L and Liu B contributed to supervision.
Institutional review board statement: This study was approved by the Ethics Committee of Wuxi People's Hospital affiliated with Nanjing Medical University (approval no. KY23117).
Informed consent statement: Owing to the retrospective nature of the study, the requirement for written informed consent was waived.
Conflict-of-interest statement: All the authors declare no conflict of interest.
Data sharing statement: The data can be obtained from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bin Liu, MM, Chief Physician, Department of Nephrology, Wuxi People's Hospital Affiliated to Nanjing Medical University, No. 299 Qingyang Road, Liangxi District, Wuxi 214023, Jiangsu Province, China. wuxi_liu@163.com
Received: November 3, 2023
Peer-review started: November 3, 2023
First decision: November 16, 2023
Revised: November 27, 2023
Accepted: November 30, 2023
Article in press: November 30, 2023
Published online: December 16, 2023
Processing time: 41 Days and 2.3 Hours
ARTICLE HIGHLIGHTS
Research background

Immunoglobulin A nephropathy (IgAN) accompanied with renal dysfunction is a common disease. There is no standard treatment for IgAN with renal dysfunction, and glucocorticoid therapy is usually administered. However, single glucocorticoid is not a complete response of IgAN with renal dysfunction. IgAN is a disease characterized by abnormal immune system, which may be due to glomerular pathological damage caused by the deposition of IgA or its circulating immune complexes in the glomerulus. Therefore, treatment with glucocorticoid and immunosuppressive drugs may be more effective for patients with IgAN with renal dysfunction.

Research motivation

IgAN is among the most prevalent primary glomerular diseases worldwide. Among primary glomerular diseases in China, IgAN accounts for 45.26%–58.2%. Furthermore, as the most prevalent primary cause of ESRD, IgAN accounts for 26.69% of ESRD cases. Glucocorticoids have been used in IgAN for many years because they have advantageous effects on reducing inflammation and urinary protein excretion. The main feature of IgAN is a change in renal immunopathology, which is often treated with immunosuppressants. Therefore, it is important to research the moderate-to-severe IgAN therapy of glucocorticoids combined with immunosuppressants.

Research objectives

To explore the efficacy and security of prednisone combined with mycophenolate mofetil in IgAN therapy with moderate-to-severe renal dysfunction. We hope that, a safer and more effective treatments will be developed.

Research methods

This study included 200 patients with moderate-to-severe renal dysfunction and IgAN patients. All patients were divided into the glucocorticoid therapy group (GTG) and immunosuppressive therapy group (ITG) according to different treatment regiments, with 100 patients in each group. The baseline data and follow-up data of patients who underwent kidney biopsy were collected. Finally, the above data were compared and analyzed.

Research results

The baseline data before treatment were not significantly different between groups. After treatment, serum creatinine and 24-h urinary protein levels in both groups decreased, but the decrease in the ITG differed from that in the GTGs in the 9th month. In addition, the overall response rate in the ITG was significantly higher than that in the GTG. The GTG had more endpoint events than the ITG, but the adverse reactions were similar between the regimens.

Research conclusions

The addition of immunosuppressants on the basis of glucocorticoids is a better treatment option for moderate-to-severe renal dysfunction in patients with IgAN.

Research perspectives

Future research will involve large-scale sample-controlled studies and long-term follow-up, and will track outcomes, relapse rates, and side effects of patients in relation to their level of renal impairment or pathological grade of their kidneys.