A Study Of Cyclophosphamide Or Leflunomide Combined With Prednisone In The Treatment Of Chronic Progressive IgA Nephropathy

Objective:To compare the efficacy and safety of cyclophosphamide (CTX) or leflunomide (LEF) combined with prednisone respectively in the treatment of chronic progressive IgA nephropathy (IgAN).Methods:A retrospective analysis during the period from October 2007 to October 2014 about IgAN patients, which were dignosed by the Second Hospital of Dalian Medical University and treated with CTX (18cases) or LEF (24cases) combined with prednisone respectively. The research’s objects needed to meet the two conditions,one was the clinical manifestations were proteinuria≥1.0g/24h, normal or mildly elevated blood pressure, renal function was midely abnormal, with or without hypoalbuminemia, another was pathology of kidney mainly indicated active, and met to LEE’s grade Ⅱ to FV. Clinical datas were collected before treatment and during induction period (i.e. treated within 6 months), including 24h-UP、Alb、Scr and adverse reaction.Results:Until the time of followed-up,24h urinary protein quantitative of the two groups showed a downward trend in overall. There was no significant difference (p>0.05) of the complete remission rate and total effective rate between the two groups. In CTX group,24h urine protein were all markedly lower than the base value followed-up 1,3 and 6 months (p<0.05); the corresponding LEF group,the urine protein reduced comparing with the base value had no statistic difference after 1,3 months’ treatment(p>0.05). However, after 6 months’treatment,24h urinary protein of the LEF group was significantly lower than the basic value (p<0.05), meantime, there was no significant difference in up to 6 months follow-up of two groups decreased urinary protein (p>0.05). Until the end of follow-up, serum albumin of patients in the two groups significantly higher than that of the basic values (p<0.05). While, LEF increased serum albumin more than that of CTX (p<0.05). Up to 6 months of treatment, compared with the base value, no significant difference(p>0.05) was found serum creatinine level in both two group. In the case of the incidence of adverse reactions, the CTX group was higher than that in LEF group (33.3% vs 12.5%).Conclusion:The treatment with CTX or LEF combined prednisone in chronic progressive IgAN has the same effect, both of them can maintain renal function stablely. But the adverse reaction rate of prednisone combined CTX is higher. Long-term efficacy and safety of observation is still needed.