The Effect of Hydroxychloroquine on Residual Proteinuria in Patients With Immunoglobulin A Nephropathy: A Retrospective Study Based on Propensity Score Matching

Overview

Journal Front Med (Lausanne)

Specialty General Medicine

Date 2022 Jul 25

PMID 35872760

Authors

Mijia Liu

Xueyan Bian

Li Wang

Guisen Li

Affiliations

Soon will be listed here.

Abstract

Background: There is insufficient evidence to support the use of hydroxychloroquine (HCQ) in Immunoglobulin A nephropathy (IgAN) patients with high residual proteinuria in spite of 6-month supportive treatment combined with corticosteroids (P) and/or immunosuppressives (IM). This study aims to explore the effect of HCQ on residual proteinuria in IgAN.

Materials And Methods: This is a retrospective study. IgAN patients who had residual proteinuria ≥0.3 g/24 h after 6-month treatment by renin-angiotensin system inhibitors (RASI) + P ± IM were included. Groups were divided based on the different regimens and then matched by the propensity score matching method. The primary outcome was defined as the cumulative frequency of residual proteinuria reduction ≥30%.

Results: RASI ( = 183), HCQ + RASI ( = 59), RASI + P ± IM ( = 145), and HCQ + RASI + P ± IM ( = 38) groups were included. HCQ + RASI group had a higher level of residual proteinuria and a worse renal function than those in the RASI group. The renal function was worse in the HCQ + RASI + P ± IM group than that in the control group, but residual proteinuria levels were similar. After matching, there were 40 patients in the first two groups and 29 patients in the latter two groups, respectively. The cumulative frequency of residual proteinuria reduction ≥30% in HCQ + RASI + P ± IM group was higher than that in control group (86.2% vs. 62.1%, χ = 6.397, = 0.011). HCQ combination treatment was one of independent factors.

Conclusion: The addition of HCQ treatment can effectively reduce the residual proteinuria in IgAN patients previously treated with supportive treatment combined with P and IM treatment and the cumulative frequency of effective reduction of residual proteinuria can reach 86.2%.

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References

Tang C, Lv J, Shi S, Chen Y, Liu L, Zhang H . Long-term safety and efficacy of hydroxychloroquine in patients with IgA nephropathy: a single-center experience. J Nephrol. 2021; 35(2):429-440. DOI: 10.1007/s40620-021-00988-1. View

Chen S, Yin Q, Ren S, Zhong X, Wang W, Li G . A comparison of the effectiveness of cyclophosphamide, leflunomide, corticosteroids, or conservative management alone in patients with IgA nephropathy: a retrospective observational study. Sci Rep. 2018; 8(1):13662. PMC: 6135814. DOI: 10.1038/s41598-018-31727-5. View

Yang Y, Liu L, Shi S, Wang J, Chen Y, Lv J . Effects of Hydroxychloroquine on Proteinuria in Immunoglobulin A Nephropathy. Am J Nephrol. 2018; 47(3):145-152. DOI: 10.1159/000487330. View

Blaas S, Stieber-Gunckel M, Falk W, Obermeier F, Rogler G . CpG-oligodeoxynucleotides stimulate immunoglobulin A secretion in intestinal mucosal B cells. Clin Exp Immunol. 2009; 155(3):534-40. PMC: 2669530. DOI: 10.1111/j.1365-2249.2008.03855.x. View

Reich H, Troyanov S, Scholey J, Cattran D . Remission of proteinuria improves prognosis in IgA nephropathy. J Am Soc Nephrol. 2007; 18(12):3177-83. DOI: 10.1681/ASN.2007050526. View

Gao R, Wu W, Wen Y, Li X . Hydroxychloroquine alleviates persistent proteinuria in IgA nephropathy. Int Urol Nephrol. 2017; 49(7):1233-1241. DOI: 10.1007/s11255-017-1574-2. View

Inker L, Schmid C, Tighiouart H, Eckfeldt J, Feldman H, Greene T . Estimating glomerular filtration rate from serum creatinine and cystatin C. N Engl J Med. 2012; 367(1):20-9. PMC: 4398023. DOI: 10.1056/NEJMoa1114248. View

Trimarchi H, Barratt J, Cattran D, Cook H, Coppo R, Haas M . Oxford Classification of IgA nephropathy 2016: an update from the IgA Nephropathy Classification Working Group. Kidney Int. 2017; 91(5):1014-1021. DOI: 10.1016/j.kint.2017.02.003. View

Lv J, Zhang H, Wong M, Jardine M, Hladunewich M, Jha V . Effect of Oral Methylprednisolone on Clinical Outcomes in Patients With IgA Nephropathy: The TESTING Randomized Clinical Trial. JAMA. 2017; 318(5):432-442. PMC: 5817603. DOI: 10.1001/jama.2017.9362. View

10.

Shen P, He L, Huang D . Clinical course and prognostic factors of clinical early IgA nephropathy. Neth J Med. 2008; 66(6):242-7. View

11.

. KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Kidney Int. 2021; 100(4S):S1-S276. DOI: 10.1016/j.kint.2021.05.021. View

12.

Thompson A, Carroll K, Inker L, Floege J, Perkovic V, Boyer-Suavet S . Proteinuria Reduction as a Surrogate End Point in Trials of IgA Nephropathy. Clin J Am Soc Nephrol. 2019; 14(3):469-481. PMC: 6419287. DOI: 10.2215/CJN.08600718. View

13.

Yang Y, Chen P, Liu L, Cai Q, Shi S, Chen Y . Comparison of the effects of hydroxychloroquine and corticosteroid treatment on proteinuria in IgA nephropathy: a case-control study. BMC Nephrol. 2019; 20(1):297. PMC: 6683466. DOI: 10.1186/s12882-019-1488-6. View

14.

Yuan Y, Che X, Ni Z, Zhong Y, Qi Y, Shao X . Association of Relapse with Renal Outcomes under the Current Therapy Regimen for IgA Nephropathy: A Multi-Center Study. PLoS One. 2015; 10(9):e0137870. PMC: 4570760. DOI: 10.1371/journal.pone.0137870. View

15.

Goto M, Wakai K, Kawamura T, Ando M, Endoh M, Tomino Y . A scoring system to predict renal outcome in IgA nephropathy: a nationwide 10-year prospective cohort study. Nephrol Dial Transplant. 2009; 24(10):3068-74. PMC: 2747499. DOI: 10.1093/ndt/gfp273. View

16.

Makita Y, Suzuki H, Kano T, Takahata A, Julian B, Novak J . TLR9 activation induces aberrant IgA glycosylation via APRIL- and IL-6-mediated pathways in IgA nephropathy. Kidney Int. 2019; 97(2):340-349. PMC: 7372907. DOI: 10.1016/j.kint.2019.08.022. View

17.

Hou J, Zhu H, Zhou M, Le W, Zeng C, Liang S . Changes in the Spectrum of Kidney Diseases: An Analysis of 40,759 Biopsy-Proven Cases from 2003 to 2014 in China. Kidney Dis (Basel). 2018; 4(1):10-19. PMC: 5848489. DOI: 10.1159/000484717. View

18.

Usui J, Yamagata K, Kai H, Outeki T, Yamamoto S, Muro K . Heterogeneity of prognosis in adult IgA nephropathy, especially with mild proteinuria or mild histological features. Intern Med. 2001; 40(8):697-702. DOI: 10.2169/internalmedicine.40.697. View

19.

Le W, Liang S, Hu Y, Deng K, Bao H, Zeng C . Long-term renal survival and related risk factors in patients with IgA nephropathy: results from a cohort of 1155 cases in a Chinese adult population. Nephrol Dial Transplant. 2011; 27(4):1479-85. DOI: 10.1093/ndt/gfr527. View

20.

Lv J, Xu D, Perkovic V, Ma X, Johnson D, Woodward M . Corticosteroid therapy in IgA nephropathy. J Am Soc Nephrol. 2012; 23(6):1108-16. PMC: 3358763. DOI: 10.1681/ASN.2011111112. View