The analysis of treatment of Immunoglobulin A-nephropathy

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Abstract


Aim. An evaluation of the effectiveness of immunosuppressive therapy (IST) and tonsillectomy (TE) in patients with IgA nephropathy (IgAN).

Materials and methods. A retrospective cohort of the study included cases with biopsy proven primary IgAN (n=367, age 34±12 years, men – 55%). We used demographic and clinical and morphological parameters at the time of biopsy. Median followup period was 26 (10; 61) months. Outcomes were remission (complete or partial) and the progression of IgAN (defined as the start of dialysis or a decrease in glomerular filtration rate ≥50% from baseline). All patients received treatment with renin angiotensin system blockers. Evaluation of the effectiveness of therapy was carried out using propensity score (PS) methods – matching, conventional double robust regression models with PS as independent covariate, and inverse probability weighting. Following patient subgroups were used for comparative analyses: with IST (n=176) and without IST (n=191); with TE (n=63) and without TE (n=304); without IST and without TE (IST-TE-; n=162); with TE and without IST (IST-TE+; n=29); with IST and without TE (IST+TE-; n=142); with IST and with TE (IST+ TE+; n=34).

Results. All PS methods used gave close estimates of the comparative effectiveness of treatment in different subgroups: 1) patients on monotherapy with corticosteroids (CS) and combination of CS with other immunosuppressants did not have significant differences in probabilities of IgAN progression (hazard ratio 0.919; 95% CI 0.333–2.950) and remission (odds ratio 0.919; 95% CI 0.379–2.344) and were further combined into a group of IST; 2) IST was significantly associated with the lower risk of disease progression and increased odds ratio for remission; 3) the positive effects of IST were limited to cases with proteinuria >2 g/24 h; 4) the likelihood of IgAN remission and progression did not differ significantly between TE+ and TE-, IST-TE+ and IST-TE- groups. There were no cases of disease progression in the IST+TE+ group. The cumulative renal survival was higher in the IST+TE+ group compared to IST+ TE- group (p=0.010), while the probability of remission did not differ.

Conclusion. IST was associated with a lower risk of IgAN progression and increased probability of remission, while these effects of IST were limited to patients with proteinuria >2 g/24 h. TE in combination with IST is associated with an additional reduction in the risk of disease progression.


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About the authors

Vladimir A. Dobronravov

Pavlov First Saint Petersburg State Medical University

Author for correspondence.
Email: dobronravov@nephrolog.ru
ORCID iD: 0000-0002-7179-5520

Russian Federation, Saint-Petersburg

д.м.н., проф., зам. дир. НИИ нефрологии, каф. пропедевтики внутренних болезней

Zinaida Sh. Kochoyan

Pavlov First Saint Petersburg State Medical University

Email: dobronravov@nephrolog.ru
ORCID iD: 0000-0001-8433-876X

Russian Federation, Saint-Petersburg

студентка лечебного фак-та

Tatyana O. Muzhetskaya

Pavlov First Saint Petersburg State Medical University

Email: dobronravov@nephrolog.ru
ORCID iD: 0000-0002-2398-0449

Russian Federation, Saint-Petersburg

врач-нефролог клиники НИИ нефрологии

Daria I. Lin

Pavlov First Saint Petersburg State Medical University

Email: dobronravov@nephrolog.ru
ORCID iD: 0000-0002-1953-637X

Russian Federation, Saint-Petersburg

студентка лечебного фак-та

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