Comparison of inhibitors of renin-angiotensin-aldosterone system (RAS) and combination therapy of steroids plus RAS inhibitors for patients with advanced immunoglobulin A nephropathy and impaired renal function.

摘要

The adaptation of steroid therapy and the effect of renin-angiotensin-aldosterone system inhibitors (RASIs) for advanced immunoglobulin A nephropathy (IgAN) patients with impaired renal function are still controversial.We divided 63 IgAN patients with an estimated glomerular filtration rate (eGFR) of <60?ml/min/1.73?m(2) and proteinuria ≥ 0.5?g/day into two groups: the RASI group (RASI, n?=?33), treated with RASIs alone; and the combination group (COMBI, n?=?30), treated with corticosteroids and RASIs. We analyzed the clinical and histological background, renal survival rate, and the risk factors for progression.Renal function (mean eGFR: COMBI 46.4 vs. RASI 47.0?ml/min/1.73?m(2)), the amount of proteinuria (median: COMBI 1.39 vs. RASI 1.17?g/g?creatinine) and histological backgrounds were not significantly different between the groups, but urinary red blood cells (U-RBCs) were significantly higher in the COMBI group than in the RASI group (median: COMBI 30.0 vs. RASI 10.0?counts/high-power field, P?=?0.0171). The serial change in proteinuria did not differ until 5 years after treatment, but U-RBCs were significantly decreased in both groups (P?