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High-dose intravenous immunoglobulin pulse therapy
in patients with progressive immunoglobulin A nephropathy: a long-term
follow-up.
Clin Exp Immunol. 2006 Oct;146(1):47-53.
Rasche FM, Keller F, Lepper PM, Aymanns C, Karges W, Sailer LC, Muller L, Czock D.
Division of Nephrology, Department of Internal Medicine I, Ulm University Hospital, Ulm, Germany.
In
progressive immunoglobulin A nephropathy (IgAN), intravenous
immunoglobulin (IVIg) treatment has been used to delay disease
progression, but the long-term efficacy is largely unknown. We report
the clinical outcomes after IVIg therapy in six male patients with
progressive IgAN [median glomerular filtration rate (GFR) 31 ml/min per
1.73 m(2)] followed for a median observation period of 8 years.
In this
single-arm, non-randomized study, IVIg was given monthly at a dose of 2
g/kg body weight for 6 months. The course of renal function was
assessed by linear regression analysis of GFR and proteinuria, and was
compared to eight patients with IgAN (median GFR 29 ml/min per 1.73
m(2)) without IVIg as a contemporaneous control group. IgAN disease
progression was delayed after IVIg therapy on average for 3 years. The
mean loss of renal function decreased from - 1.05 ml/min per month to -
0.15 ml/min per month (P = 0.024) and proteinuria decreased from 2.4
g/l to 1.0 g/l (P = 0.015). The primary end-point (GFR < 10 ml/min
or relapse) occurred 5.2 years (median; range 0.4-8.8) after the first
IVIg pulse, and after 1.3 years (median; range 0.8-2.4) in the control
group (P = 0.043). In Kaplan-Meier analysis, the median renal survival
time with IVIg was prolonged by 3.5 years (IVIg 4.7 years versus
control 1.2 years; P = 0.006). IVIg pulse therapy may be considered as
a treatment option to reduce the loss of renal function and improve
proteinuria in patients with progressive IgAN.
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