Patients with IgA vasculitis nephritis achieved remission using immunosuppression therapy
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Pediatric patients with IgA vasculitis nephritis and nephrotic-range proteinuria achieved remission after 12 months of mycophenolate mofetil-based immunosuppression treatment, according to data published in Kidney Medicine.
“Currently, there is no consensus on treatment for patients with severe [IgA vasculitis nephritis] IGAVN. Multiple immunosuppressive protocols have been advocated and used with varying results,” Dmitry Samsonov, MD, from the division of nephrology in the department of pediatrics at Maria Fareri Children’s Hospital of New York College in Vahalla, New York, and colleagues wrote. “Results of our case series support previous studies that demonstrated that a combination of steroids and mycophenolate mofetil can be effective for treating children with IGAVN and nephrotic-range proteinuria.”
In a case series between Jan. 1, 2000, and Dec. 31, 2018, researchers retrospectively examined data from 12 children (eight were boys; four were girls; mean age was 7.5 years) who presented with IGAVN, cutaneous purpura and nephrotic-range proteinuria.
Before patients began immunosuppression, the mean urinary protein-to-creatinine ratio (UPC) among patients was about 12.5 mg/mg and the GFR was about 90.7 mL/min/1.73 m2. Patients received steroids (2 mg/kg) for 8 weeks daily, then every other day (1.5 mg/kg) before tapering off of treatment. They also received mycophenolate mofetil treatment (1,257 ± 275 mg/m2 /day) for about 10.2 months.
Researchers sought to determine the time necessary to reach remission of proteinuria, resolution of hematuria, and GFR at 12 months and last follow-up.
By the 12-month follow-up, all patients achieved remission of proteinuria and regular kidney function. At the final follow-up, a mean of 33.5 months, all but one patient remained in remission and maintained a normal GFR. Similarly, all patients successfully stopped immunosuppression. Researchers did not observe any adverse events related to the mycophenolate mofetil treatment.
“In our study, time to achieve remission of proteinuria correlated with degree of proteinuria at presentation. To our knowledge, this is the first time when such correlation has been observed. Degree of proteinuria might be a key laboratory finding determining severity of disease and requiring more aggressive approach,” Samsonov and colleagues wrote. “Additional studies are needed to address whether treatment should be stratified based on degree of proteinuria and whether earlier initiation of immunosuppressive therapy improves the outcomes.”
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