Clinical Course of Patients with IgA Nephropathy between Combined Treatment of Immunosuppressive Agents and ACE Inhibitor and ACE Inhibitor alone

BACKGROUND It has not been clear whether immunosuppressive therapy favorably influences renal function and proteinuria in IgA nephropathy (IgAN). Angiotensin converting enzyme inhibitor (ACEi) has an anti-proteinuric effect in IgAN. A retrospective study was done to see whether the addition of immunosuppressive therapy to ACEi produces a more excellent anti-proteinuric effect and preserves better renal function than ACEi alone. METHODS A total of 49 patients with proteinuria > 1.0 g/day and serum creatinine concentrations < 1.5 mg/dL were followed-up from at least 1 year to 9 years. Among them, 25 patients were treated with the combination of cyclophosphamide, prednisolone and ACEi while the other 24 were treated with ACEi alone. RESULTS The combination therapy or ACEi alone both reduced proteinuria with significant value (the combination group: from 5.74 +/- 5.08 to 2.29 +/- 2.77 g/day, ACEi group: from 3.85 +/- 2.54 to 1.68 +/- 1.91 g/day), while no significant differences in reduction of proteinuria were noticed between the two groups. There was no significant elevation of serum creatinine in both groups during follow-up (the combination group: from 0.91 +/- 0.20 to 1.03 +/- 0.38 mg/dL, ACEi group: from 0.93 +/- 0.27 to 0.99 +/- 0.37 mg/dL). This study showed no significant differences in the change in slope of 1/serum creatinine levels during the follow-up period between the two groups. CONCLUSION We conclude that immunosuppressive therapy may not be beneficial in patients with proteinuric IgAN. ACEi may be a valuable therapeutic agent avoiding serious side effects of immunosuppressive agents.