Advertisement

Clinical and Experimental Nephrology

, Volume 22, Issue 5, pp 1143–1149 | Cite as

Initial treatment with pulse methylprednisolone followed by short-term prednisolone and tonsillectomy for childhood IgA nephropathy

  • Akifumi Yamada
  • Shuichiro FujinagaEmail author
  • Koji Sakuraya
  • Asanuma Satoshi
  • Daishi Hirano
Original article

Abstract

Background

Although a combination therapy, comprising 2-year high-dose oral prednisolone (PSL), is effective for treating childhood immunoglobulin A nephropathy (IgAN), severe adverse effects and residual proteinuria occur in some patients after the therapy.

Methods

To clarify the efficacy of intravenous pulse methylprednisolone (IVMP; 15–20 mg/kg; maximum 600 mg/day; for 3 consecutive days/week for 3 weeks) followed by short-term reduced-dose PSL (initially 1 mg/kg; maximum 30 mg on alternate days; tapered off within approximately 12 months) and tonsillectomy as an initial treatment, we retrospectively reviewed the clinical courses of 54 consecutive children with IgAN (32 boys; mean age at onset, 12.2 years; follow-up period of > 2 years) after initiating the treatment. According to the Japanese pediatric IgAN guidelines, we divided the 54 patients into the following two groups: group 1, comprising 24 patients with severe IgAN, and group 2, comprising 30 patients with mild IgAN.

Results

After the treatment, proteinuria disappeared in all patients at a median of 1.6 months (group 1, 2.8 months; group 2, 0.4 months) and hematuria disappeared in 47 patients (87%) at a median of 13.2 months (group 1, 15.9 months; group 2, 13.2 months). During the follow-up period (median 5 years), no severe adverse effects were observed in any patient. At the last visit, although two patients (4%) had mild proteinuria, none developed hypertension or renal insufficiency.

Conclusions

As an initial treatment, IVMP followed by short-term PSL and tonsillectomy appears to be effective for treating childhood IgAN.

Keywords

Intravenous pulse methylprednisolone Short-term oral prednisolone Tonsillectomy Childhood IgA nephropathy 

Notes

Compliance with ethical standards

Conflict of interest

The authors have declared that no conflict of interest exists.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (approved number 2017-99-018) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Yoshikawa N, Igarashi T, Ishikura K, Kaku Y, Nakazato H, Kamei K, Kawamura T, Nakamura H, Yamamoto Y, Nakanishi K, Sako M. Guidelines for the treatment of childhood IgA nephropathy. Nihon Jinzo Gakkai Shi. 2008;50:31–41.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Matsuzaki K, Suzuki Y, Nakata J, Sakamoto N, Horikoshi S, Kawamura T, Matsuo S, Tomino Y. Nationwide survey on current treatments for IgA nephropathy in Japan. Clin Exp Nephrol. 2013;17:827–33.CrossRefGoogle Scholar
  3. 3.
    Hotta O, Miyazaki M, Furuta T, Tomioka S, Chiba S, Horigome I, Abe K, Taguma Y. Tonsillectomy and steroid pulse therapy significantly impact on clinical remission in patients with IgA nephropathy. Am J Kidney Dis. 2001;38:736–43.CrossRefGoogle Scholar
  4. 4.
    Ieiri N, Hotta O, Sato T, Taguma Y. Significance of the duration of nephropathy for achieving clinical remission in patients with IgA nephropathy treated by tonsillectomy and steroid pulse therapy. Clin Exp Nephrol. 2012;16:122–9.CrossRefGoogle Scholar
  5. 5.
    Fujinaga S, Ohtomo Y, Hirano D, Nishizaki N, Someya T, Ohtsuka Y, Kaneko K, Shimizu T. Low-dose pulse methylprednisolone followed by short-term combination therapy and tonsillectomy for childhood IgA nephropathy. Pediatr Nephrol. 2010;25:563–4.CrossRefGoogle Scholar
  6. 6.
    Kawasaki Y, Maeda R, Kanno S, Suzuki Y, Ohara S, Suyama K, Hosoya M. Long-term follow up of pediatric immunoglobulin A nephropathy treated with tonsillectomy plus methylprednisolone pulse therapy. Pediatr Int. 2017;59:41–7.CrossRefGoogle Scholar
  7. 7.
    Uemura O, Nagai T, Ishikura K, Ito S, Hataya H, Gotoh Y, Fujita N, Akioka Y, Kaneko T, Honda M. Creatinine-based equation to estimate the glomerular filtration rate in Japanese children and adolescents with chronic kidney disease. Clin Exp Nephrol. 2014;18:626–33.CrossRefGoogle Scholar
  8. 8.
    Trimarchi H, Barratt J, Cattran DC, Cook HT, Coppo R, Haas M, Liu ZH, Roberts IS, Yuzawa Y, Zhang H, Feehally J, IgAN Classification Working Group of the International IgA Nephropathy Network and the Renal Pathology Society; Conference Participants. Oxford classification of IgA nephropathy 2016: an update from the IgA nephropathy classification working group. Kidney Int. 2017;91:1014–21.CrossRefGoogle Scholar
  9. 9.
    Yoshikawa N, Honda M, Iijima K, Awazu M, Hattori S, Nakanishi K, Ito H, Japanese Pediatric IgA Nephropathy Treatment Study Group. Steroid treatment for severe childhood IgA nephropathy: a randomized, controlled trial. Clin J Am Soc Nephrol. 2006;1:511–7.CrossRefGoogle Scholar
  10. 10.
    Yoshikawa N, Ito H, Sakai T, Takekoshi Y, Honda M, Awazu M, Ito K, Iitaka K, Koitabashi Y, Yamaoka K, Nakagawa K, Nakamura H, Matsuyama S, Seino Y, Takeda N, Hattori S, Ninomiya M. A controlled trial of combined therapy for newly diagnosed severe childhood IgA nephropathy. The Japanese Pediatric IgA Nephropathy Treatment Study Group. J Am Soc Nephrol. 1999;10:101–9.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Kamei K, Nakanishi K, Ito S, Ishikura K, Hataya H, Honda M, Nozu K, Iijima K, Shima Y, Yoshikawa N, Japanese Pediatric IgA Nephropathy Treatment Group. Risk factors for persistent proteinuria after a 2-year combination therapy for severe childhood IgA nephropathy. Pediatr Nephrol. 2015;30:961–7.CrossRefGoogle Scholar
  12. 12.
    Jauhola O, Ronkainen J, Autio-Harmainen H, Koskimies O, Ala-Houhala M, Arikoski P, Hölttä T, Jahnukainen T, Rajantie J, Ormälä T, Nuutinen M. Cyclosporine A vs. methylprednisolone for Henoch–Schönlein nephritis: a randomized trial. Pediatr Nephrol. 2011;26:2159–66.CrossRefGoogle Scholar
  13. 13.
    Nakanishi K, Iijima K, Ishikura K, Hataya H, Awazu M, Sako M, Honda M, Yoshikawa N, Japanese Pediatric IgA Nephropathy Treatment Study Group. Efficacy and safety of lisinopril for mild childhood IgA nephropathy: a pilot study. Pediatr Nephrol. 2009; 24:845–9.CrossRefGoogle Scholar
  14. 14.
    Shima Y, Nakanishi K, Hama T, Mukaiyama H, Togawa H, Sako M, Kaito H, Nozu K, Tanaka R, Iijima K, Yoshikawa N. Spontaneous remission in children with IgA nephropathy. Pediatr Nephrol. 2013;28:71 – 6.CrossRefGoogle Scholar
  15. 15.
    Gutiérrez E, Zamora I, Ballarín JA, Arce Y, Jiménez S, Quereda C, Olea T, Martínez-Ara J, Segarra A, Bernis C, García A, Goicoechea M, García de Vinuesa S, Rojas-Rivera J, Praga M. Grupo de Estudio de Enfermedades Glomerulares de la Sociedad Española de Nefrología (GLOSEN): long-term outcomes of IgA nephropathy presenting with minimal or no proteinuria. J Am Soc Nephrol. 2012;23:1753–60.CrossRefGoogle Scholar
  16. 16.
    Szeto CC, Lai FM, To KF, Wong TY, Chow KM, Choi PC, Lui SF, Li PK. The natural history of immunoglobulin a nephropathy among patients with hematuria and minimal proteinuria. Am J Med. 2001;15:434–7.CrossRefGoogle Scholar
  17. 17.
    Lai FM, Szeto CC, Choi PC, Li PK, Chan AW, Tang NL, Lui SF, Wang AY, To KF. Characterization of early IgA nephropathy. Am J Kidney Dis. 2000;36:703–8.CrossRefGoogle Scholar
  18. 18.
    Shen P, He L, Huang D. Clinical course and prognostic factors of clinical early IgA nephropathy. Neth J Med. 2008;66:242–7.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Coppo R. Is a legacy effect possible in IgA nephropathy? Nephrol Dial Transplant. 2013;28:1657–62.CrossRefGoogle Scholar
  20. 20.
    Kawamura T, Yoshimura M, Miyazaki Y, Okamoto H, Kimura K, Hirano K, Matsushima M, Utsunomiya Y, Ogura M, Yokoo T, Okonogi H, Ishii T, Hamaguchi A, Ueda H, Furusu A, Horikoshi S, Suzuki Y, Shibata T, Yasuda T, Shirai S, Imasawa T, Kanozawa K, Wada A, Yamaji I, Miura N, Imai H, Kasai K, Soma J, Fujimoto S, Matsuo S, Tomino Y, Special IgA Nephropathy Study Group. A multicenter randomized controlled trial of tonsillectomy combined with steroid pulse therapy in patients with immunoglobulin A nephropathy. Nephrol Dial Transplant. 2014; 29:1546–53.CrossRefGoogle Scholar
  21. 21.
    KDIGO clinical practice guideline for glomerulonephritis. Chapter 10: immunoglobulin A nephropathy. Kidney Int Suppl 2012; 2:209–17.Google Scholar
  22. 22.
    Hirano K, Amano H, Kawamura T, Watanabe K, Koike K, Shimizu A, Endo S, Tsuboi N, Okonogi H, Miyazaki Y, Ikeda M, Hanaoka K, Ogura M, Komatsumoto S, Yokoo T. Tonsillectomy reduces recurrence of IgA nephropathy in mesangial hypercellularity type categorized by the Oxford classification. Clin Exp Nephrol. 2016;20:425–32.CrossRefGoogle Scholar
  23. 23.
    Matsushita S, Ishikura K, Okamoto S, Okuda Y, Nagaoka Y, Harada R, Hamada R, Sakai T, Hamasaki Y, Hataya H, Ando T, Ogata K, Honda M. Long-term morbidity of IgA nephropathy in children evaluated with newly proposed remission criteria in Japan. Clin Exp Nephrol. 2015;19:1149–56.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Nephrology 2018

Authors and Affiliations

  • Akifumi Yamada
    • 1
    • 2
  • Shuichiro Fujinaga
    • 1
    Email author
  • Koji Sakuraya
    • 1
    • 3
  • Asanuma Satoshi
    • 4
  • Daishi Hirano
    • 2
  1. 1.Division of NephrologySaitama Children’s Medical CenterSaitama cityJapan
  2. 2.Department of PediatricsThe Jikei University School of MedicineTokyoJapan
  3. 3.Department of PediatricsJuntendo University School of MedicineTokyoJapan
  4. 4.Division of OtorhinolaryngologySaitama Children’s Medical CenterSaitamaJapan

Personalised recommendations