期刊
CLINICAL AND EXPERIMENTAL NEPHROLOGY
卷 20, 期 1, 页码 87-93出版社
SPRINGER
DOI: 10.1007/s10157-015-1140-0
关键词
IgG4-related disease; Chronic kidney disease; Tubulointerstitial nephritis; Glucocorticoid; Follow-up
资金
- Ministry of Health, Labor and Welfare, Japan
- 'IgG4-related Kidney Disease' working group of the Japanese Society of Nephrology
- Grants-in-Aid for Scientific Research [26461487] Funding Source: KAKEN
Although renal dysfunction in IgG4-related kidney disease (IgG4-RKD) shows rapid resolution with glucocorticoid therapy, little is known about the appropriate initial glucocorticoid dose for induction therapy or long-term renal outcome. We retrospectively examined the differences in recovery of renal function according to the dose of glucocorticoid used for induction therapy and the long-term renal outcome in 43 patients with definite IgG4-RKD (mostly IgG4-tubulointerstitial nephritis), in whom the estimated glomerular filtration rate (eGFR) before glucocorticoid therapy was < 60 ml/min. Most patients were treated with glucocorticoid alone and had been maintained on glucocorticoid. The initial dose of prednisolone employed was a parts per thousand currency sign0.6 mg/kg/day (mean 0.47) in 27 patients (group L), and > 0.6 mg/kg/day (mean 0.81) in 16 patients (group H). In both groups, the pretreatment eGFR was significantly improved at 1 month after the start of glucocorticoid therapy and the degree of improvement showed no significant inter-group difference. Relapse of IgG4-RKD occurred in 16.7 % of the group L patients and 13.3 % of the group H patients (p = 0.78). Among 29 patients who were followed up for over 36 months (mean 74 months) and had been maintained on glucocorticoid, none showed progression to end-stage renal disease and there was no significant difference between eGFR at 1 month after treatment and eGFR at the last review. In glucocorticoid monotherapy for IgG4-RKD, a moderate dose is sufficient for induction, and recovery of renal function can be maintained for a long period on low-dose maintenance, although relapse can occur even in patients receiving maintenance therapy.
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