@article{oai:twinkle.repo.nii.ac.jp:00019273,
 author = {KOIKE, Minako and HONDA, Kazuho and MORIYAMA, Takahito and NITTA, Kosaku and NIHEI, Hiroshi},
 issue = {6/7},
 journal = {東京女子医科大学雑誌},
 month = {Jul},
 note = {IgA腎症患者に対するステロイド剤の有効投与量の決定に関しては不明な点が多い.今回われわれは,腎生検時の血清クレアチニン値が0.62mg/dlから1.58mg/dlの範囲のIgA腎症患者20例を対象に,低用量ステロイド剤の有効性について検討した.腎生検で軽度の炎症性変化を示した症例に, 1日20～30mgのステロイド剤の投与を行った.ステロイド治療前後の血清クレアチニン値の変化によって2つの群に分類した.グループ1は血清クレアチニン値が低下または変化がなかった群,グループ2は血清クレアチニン値が上昇した群である.検討した20例すべてにおいて,ステロイド治療による血清クレアチニン値の有意な変化は認められなかった.しかし,ステロイド治療12ヵ月後に蛋白尿は有意に減少した(1.0±0.8g/day vs. 0.5±1.1g/day, p=0.0202).また,ステロイド治療12ヵ月後に血尿は有意に減少した. (30.0±32.7RBC/HPF vs. 6.1±6.7RBC/HPF, p=0.0032). ステロイド治療中の収縮期および拡張期血圧の有意な変化はなかった.腎生検所見を比較すると,グループ2に比しグループ1で動脈硬化の程度は軽度であった(0.4±0.5 vs. 0.8±0.4,p=0.001).今回の結果から,腎生検で軽度の炎症性変化を示し,軽度の血管病変を有するIgA腎症患者では,低用量ステロイド剤治療により,蛋白尿が有意に減少し腎機能障害の進展が阻止される可能性が示唆された., The effectiveness of low-dose steroid therapy has not been determined in patients with IgA nephropathy. Twenty IgA nephropathy patients whose serum creatinine levels ranged from 0.62mg/dl to 1.58mg/dl at the time of renal biopsy were studied. The patients, with mild inflammatory activities such as cellular and/or fibro-cellular crescents, mesangial interposition with mononuclear cell infiltration, and interstitial inflammatory cell infiltration, were treated with prednisolone (20-30mg/day). The patients were then divided into two groups according to changes in the serum creatinine levels after steroid therapy: group I, improved renal function or no significant changes in renal function; group II, deterioration of renal function. In all of the patients studied, serum creatinine levels did not significantly change during steroid therapy (p=0.4493). However, proteinuria significantly reduced after 12 months of steroid therapy (1.0±0.8g/day vs. 0.5±1.1g/day, p=0.0202). In addition, hematuria significantly reduced after 12 months of steroid therapy (30.0±32.7 RBC/HPF vs. 6.1±6.7 RBC/HPF, p=0.0032). Blood pressure did not significantly change during steroid therapy. When serum creatinine levels were compared over the time course, the grade of arteriosclerosis was lower in group I than in group II (0.4±0.5 vs. 0.8±0.4, p=0.001). In conclusion, our data suggested that low-dose steroid therapy for IgA nephropathy patients with mild inflammatory activities could reduce the amount of urinary protein excretion and prevent deterioration of renal function, provided the histological findings in the renal biopsies showed mild arteriosclerosis.},
 pages = {305--313},
 title = {Effect of Low Dose-Steroid Therapy in Patients with IgA Nephropathy},
 volume = {74},
 year = {2004}
}