tag:blogger.com,1999:blog-4230162007222918868.post2325707976904503939..comments2023-09-19T05:50:03.130-04:00Comments on Renal Fellow Network: Stop-IgA: Immunosuppression for proteinuric IgA NephropathyGearoid McMahonhttp://www.blogger.com/profile/08049723797363526138noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-4230162007222918868.post-35490806233851845762016-03-13T20:23:08.951-04:002016-03-13T20:23:08.951-04:00At the first glance, this trial looks very well co...At the first glance, this trial looks very well conducted and its findings sounds convincing. Unfortunately, an in-depth review of the STOP IgAN reveals a considerable number of limitations that may render results inconclusive.<br /><br />1- Histology:<br />Although the inclusion criteria required a biopsy-proven IgAN, it has completely ignored the histological classification of the disease and hence the trial comprised a mixed bag of IgAN patients with a possible wide variation in histological findings that could predict disease progression. Previous studies showed that widespread glomerulosclerosis and marked tubulointerstitial lesions were strong predictors of disease progression.<br /><br />2- Haematuria:<br />It was shown previously that gross haematuria in IgAN is associated with slow disease progression. In STOP IgAN, even though the number of patients without haematuria was small, authors did not tell us if any of the patients without haematuria develop the primary outcome.<br /><br />3- Follow up:<br />IgAN is characterized by an extreme variability in clinical course and sometimes by the unpredictability of the ultimate outcome. Approximately, 15 to 40 percent of patients with a progressive disease, excluding the crescentic subtype, will progress to end-stage renal disease over 10 to 20 years period. Therefore, drawing conclusions will be premature if the follow-up period is shorter than 10 years, as in this trial. Moreover, most of the immunosuppression group (67%, n=55) received only a 6-month corticosteroids course, which is quite arbitrary. This regime is of extremely short duration and is unlikely to have any impact on the outcome of a disease that progresses over a decade or two.<br /><br />In conclusion, the STOP IgAN trial emphasized the dilemmas and potential complications of treating patients with a clinical and pathologic phenotype of IgA nephropathy. It also demonstrated that proper supportive care is helpful, at least in the short run. Definitely we need to improve our basic understanding of IgA nephropathy before we can design better trials that will allow us to draw definitive conclusions about treatment strategies.Anonymoushttps://www.blogger.com/profile/00978927993325598876noreply@blogger.comtag:blogger.com,1999:blog-4230162007222918868.post-69049263685642349402015-12-21T17:55:28.918-05:002015-12-21T17:55:28.918-05:00We have not population characteristic to interpret...We have not population characteristic to interpret roughly the result of this trial. Inclusion criteria excluded all the inflammatory form fo the disease. Proteinuria end point (0,75 g) is not clear. This threshold is very uncommon. I'm surprised by the NEJM to publish this article.dodoIgANnoreply@blogger.comtag:blogger.com,1999:blog-4230162007222918868.post-66894840364469641162015-12-20T12:52:33.185-05:002015-12-20T12:52:33.185-05:00The study used cyclophosphamide in those with CKD...The study used cyclophosphamide in those with CKD stage 4 which is associated with extensive interstitial fibrosis . At this advanced stage it is likely to be countreproductive by increasing the chances of infection.sampathhttps://www.blogger.com/profile/18107669346765803581noreply@blogger.com