A risk of overtreatment versus a lost ‘golden period’ Many Japanese nephrologists feel that patients with early-stage or mild IgA Idasanutlin cost nephropathy respond readily to TSP or steroid

pulse therapy. On the other hand, patients with proteinuria >1.0 g/day and creatinine clearance (CCr) <70 ml/min are resistant not only to TSP but also to oral steroid therapy. The ‘golden period’ exists when patients have proteinuria <1.0 g/day. Preservation of kidney function versus induction of clinical remission The goal of many clinical studies is the preservation of renal function. However, Hotta et al. emphasized that TSP can induce CR and demonstrated that patients who respond to TSP could maintain their kidney function. Some Japanese nephrologists are shifting from a paradigm of preserving kidney function to inducing CR. What is the overall natural history of IgA nephropathy? Chauveau and Droz [4] studied the natural history of IgA nephropathy learn more in 1993. In a series of 119 patients with biopsy-proven IgA nephropathy from 1968 to 1972 at Necker Hospital, 74 patients (44 men and 30 women) received no therapy. Of this

subset, 22 patients (29.7%) showed spontaneous remission, defined as no urinary abnormalities and normal kidney function, 24 patients (32.4%) had urinary abnormalities without aggravation of kidney function, and 28 patients (37.8%) progressed to end-stage renal failure during a 20-year observation period (Table 1). Table 1 A natural history of IgA nephropathy at Necker Hospital   Chauveau

and Droz Observation period 20 years Number selleck chemical Acesulfame Potassium of patients 74 Spontaneous remission 29.7% Persistent urinary abnormalities without aggravation of kidney function 32.4% End-stage renal failure 37.8% Do patients with mild or early-stage IgA nephropathy recover or progress? Szeto et al. reported on the natural history of mild or early-stage IgA nephropathy in patients with proteinuria <0.4 g/day over an observation period of 7 years [ 5 ]. About 40% of these patients showed a progressive course—33% had proteinuria increased to >1.0 g/day, and 7% had decreased kidney function defined as CCr <70 ml/min/1.73 m2. Another 42% of patients had persistent proteinuria and hematuria; however, 14% of patients reached CR that the authors defined as the disappearance of hematuria (Table 2). Table 2 The natural history of patients with mild or early-stage IgA nephropathy   Shen et al. Szeto et al. Daily proteinuria <0.03 g >0.03, <0.3 g Total (<0.3 g) <0.4 g Observation period   92 ± 28 months 84 (14–180) months Number of patients 50 85 135 72 Disappearance of hematuria 22% 6% 12% 14% Increased proteinuria (>1.0 g) 6% 42% 29% 33% Hypertension 12% 44% 32% 19% Decreased kidney function 4% 29% 20% 7% Shen et al. also analyzed the natural history of IgA nephropathy with isolated microscopic hematuria, defined as no detection of urinary protein by dipstick [6]. They compared patients with no proteinuria (<0.03 g/day) and microalbuminuria (0.03–0.