Investigation Of Treatment Of1,25（OH）₂D₃on IgA Nephropathy And Its Effect On The Immune System

Background Immunoglobulin A nephropathy （IgAN） is the most commonglomerulonephritis in the world, and it takes up about30%⁵0%of the primaryglomerulonephritis in China. In10to20years after IgAN is diagnosed,30%⁴0%patients progress to the end-stage renal disease （ESRD）. So how to prevent and cureIgAN and delay the progress to the renal failure stage is one of the hottest issues inthe current globle field of kidney disease. Researches have been proved that hypert-ension,proteinuria,decline of renal function and lesions of glomerulus are importantfactors that affect the process of IgAN. So they are not only important indexes for aclinician to chose the corresponding treatment, but also the judgement for the effect.Glucocorticoid can be used for IgAN which manifests as nephrotic syndome, plusimmunosuppressant such as cyclophosphamide when necessary. But for the patientswho manifest as non-obviousness proteinuria, nonspecific treatments such as ACEIand anticoagulation are usually used. The mechanism of IgAN has not been completely clear yet,but it’s consideredthat immune and heredity factor are very important to IgAN. The extensive used ofimmunosuppressive agent prompts the importance of immune factors. However, thepresent immunosuppressive agents have serious side effects. Therefore, looking foran immunosuppressive agent with little side effects has been a new target in the tre-atment of IgAN.Many researches have been confirmed that1,25（OH）₂D₃could notonly regulate calcium and phosphorus but also regulate the immune system. It hasbeen supposed to be a new type of immunosuppressant which has been used to treatthe immune-related diseases. However, for now there are very few reports about thetreatment of1,25（OH）₂D₃on IgA nephropathy home and abroad. Our study is asingle center and prospective study with randomized controlled trial. The aim is toinvestigate the effect and safety of treatment of1,25（OH）₂D₃on IgA nephropathy,and to discuss its effect on the immune system.Objective To investigate the effect and safety of treatment of1,25（OH）₂D₃on IgA nephropathy, and to discuss its effect on the immune system.Methods45IgA nephropathy patients in the nephrology department wardsbetween January2009to December2010were enrolled, with proteinuria between0.5g/24h to2.0g/24h and Ccr≥60ml/min per1.73m2, eliminate the patients withsecondary glomerulonephritis, serious disease in heart,liver and brain,and tumour.Proteinuria, blood creatinine（Cr）,blood calcium and T cell subset weredetected.The patients were randomly divided into three groups.Patients in irbesartagroup（ARB）were treated with erbesartan150mg/d.Patients in rocaltrol group（VD3）were treated with rocaltrol0.25ug/d,and patients in combined treatmentgroup（ARB+VD3） were treated with Erbesartan150mg/d and rocaltrol0.25ug/d.Each group consisted of15patients. All patients were treated with low salt,low fat, quality low-protein diet and dipyridamole150mg/d.The patients with high blood pressure were treated with Calcium Channel Blockers.After12weeks,theabove indicator were checked again.Results1.The mean age of patients was （33.56±8.24） years old. There were nosignificant differences in age, proteinuria,Cr and kidney pathology grade（mesangial proliferative,glomerulosclerosis,renal tubulointerstitial lesions） amongthe three group before treatment （P>0.05）.2.After treatment,proteinuria of group ARB was significantly decreased[（976.75±115.95） vs （570.25±65.78） mg/24h, P<0.05].Proteinuria of groupARB+VD3was significantly decreased [（930.88±140.34）vs （286.13±71.57）mg/24h,P<0.01], and was significantly lower than that in VD3group（P<0.05）.3.There was no adverse reaction in the patients,and nobody gothypercalcemia,.4Afer treatment,CD4+/CD8+significantly descended in group ARB+VD3([（1.61±0.40）vs（1.25±0.50）, P<0.05].,and was significantly lower than that inARB group （P<0.05）.Conclusion1.Rocaltrol combined with ARB can reduce proteinuria of IgA nephropathy,more effectively rocaltrol solo，and there is few severe side-effects,therefore,theymay be considered as a new therapeutic method for IgA nephropathy.2.Rocaltrol combined with ARB could decrease the ration of CD4⁺/CD8⁺.