Journal of nephrology
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Journal of nephrology · May 2008
Randomized Controlled Trial Multicenter Study Comparative StudySupportive Versus Immunosuppressive Therapy of Progressive IgA nephropathy (STOP) IgAN trial: rationale and study protocol.
The best treatment of IgA nephropathy (IgAN) is currently not well defined. The Supportive Versus Immunosuppressive Therapy of Progressive IgA Nephropathy (STOP IgAN) trial aims to answer if, in IgAN patients, an immunosuppressive treatment is more effective than a supportive treatment. ⋯ In a randomized prospective multicenter study (www.clinicaltrials.gov, NCT00554502), we will treat 148 patients at risk for progressive IgA nephropathy following a 6-month run-in phase, in 2 groups: (group a) supportive treatment: patients with a persistent proteinuria >0.75 g/day will receive a maximized therapy to reduce blood pressure and urinary protein loss using angiotensin-converting enzyme inhibitors and AT1 blockers, statins, dietary counseling for a low-sodium and low-protein diet and education/intervention programs to stop smoking. (group b) immunosuppressive treatment: in addition to the identical treatment of group a, patients will receive treatment with steroids (glomerular filtration rate [GFR] > or =60 ml/min) or steroids plus cyclophosphamide/azathioprine (GFR <60 ml/min). Study end points are the complete remission of the disease and the individual degree of renal functional loss. If the immunosuppressive therapy shows a superior efficacy with respect to prevention of renal failure, the potentially higher therapy cost and risk might be justified. Finally, our trial can serve as a model for various other types of glomerulonephritis, for which such trials are very difficult to perform, given their infrequency.
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Journal of nephrology · May 2008
ReviewMetabolic syndrome and chronic kidney disease: a Japanese perspective on a worldwide problem.
Metabolic syndrome and obesity have causative roles in the development of chronic kidney disease (CKD). CKD leads to end-stage renal disease (ESRD), cardiovascular disease and death. The prevalence of metabolic syndrome is increasing worldwide in both developing and developed countries. ⋯ A fundamental scientific question is the ethnic factor for calculating the glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease Study equation. The incidence and prevalence of CKD are closely related with lifestyle factors such as diet, exercise, tobacco use, as well as other cultural differences. Research on the relationship between CKD and metabolic syndrome may provide clues to better understand the role of lifestyle-related factors and the age-related decline in GFR.