ESPN 53rd Annual Meeting

ESPN 2021


 
Efficacy of combined therapy of Azathioprine, Prednisone and Enalapril in IgAN and IgAVN children including control kidney biopsy
MALGORZATA MIZERSKA-WASIAK 1 JADWIGA MALDYK 2 MILOSZ STARCZYNSKI 3 WOJCIECH WASIAK 3 MALGORZATA PANCZYK-TOMASZEWSKA 1

1- DEPARTMENT OF PEDIATRICS AND NEPHROLOGY, MEDICAL UNIVERSITY OF WARSAW, POLAND
2- DEPARTMENT OF PATHOLOGY, MEDICAL UNIVERSITY OF WARSAW, POLAND
3- STUDENT’S SCIENTIFIC GROUP AT THE DEPARTMENT OF PEDIATRICS AND NEPHROLOGY, MEDICAL UNIVERSITY OF WARSAW, POLAND
 
Abstract:

IgA nephropathy (IgAN) and IgA vasculitis nephritis (IgAVN) are glomerulonephritis in which immunosuppressive therapy may be used.

The aim of this study was to evaluate the efficacy of 1-year treatment with Azathioprine with Prednisone and Enalapril including control renal biopsy in children with IgAN and IgAVN.

Material and Methods: This retrospective study consist of 36 children :15 IgAN, 21 IgAVN, diagnosed in kidney biopsy. All children were treated with Azathioprine 12 months, Prednisone- 15 months (gradually diminished according to the protocol) and Enalapril. Before the biopsy and at the end of treatment we analyzed: proteinuria, hematuria, creatinine, GFR.  After the treatment control kidney biopsy was performed in all patients ; results of biopsies were classified ac. to the Oxford classification.

Results: At the onset of the disease proteinuria and GFR were higher in IgAVN children than IgAN (median 64 (5.79-190) mg/kg/d vs 15 (7-177) mg/kg/d, p<0.01; 127.15 ± 35.11 vs 102.41±  30.1, p<0.05); hematuria (NS). Kidney biopsy was performed significantly later in children with IgAN than IgAVN (1.01 ±1.03 vs 0.11±0.11 years, p<0.0002. In first biopsy MEST-C score was not significantly different between IgAN and IgAVN.

Et the end of combined therapy we found significant reduction of proteinuria (proteinuria=0 in 35 patients, and hematuria. GFR and creatinine were normal in all patients of both groups. In Oxford classification we noted significant improvement in M,E between first and second biopsy in both groups (M p<0.01 in IgAN and IgAVN , E p<0.01 in IgAN , p<0.05 in IgAVN)  and additionally T only in IgAVN (p<0.001).

We observed significantly higher percent of patients with S0,T0 and C0 after treatment in IgAVN than IgAN.

Conclusions: 1- year combined therapy of Azathioprine, Prednisone and Enalapril leads to clinical and histological improvement in children with IgAN and IgAVN.