The present study also revealed that the number of years from dia

The present study also revealed that the number of years from diagnosis until TSP does not necessarily influence the CR rate; when patients have between 0.3 and 1.09 g/day of urinary protein, the CR rate is approximately 70 %, independent of the number of years from diagnosis until TSP. On the other hand, the number of years form diagnosis until TSP is an important factor in patients with more than 1.1 g/day of urinary protein, because the CR rate was 23 % in patients with more than 6 years from diagnosis until TSP compared to 43 % in patients with <6 years from diagnosis until TSP (P = 0.01). The above results suggest that urinary protein is a more

essential predictive factor than the number of years from diagnosis until TSP. Regarding resistance to TSP, based on multivariate logistic regression analysis we previously reported that resistance to TSP therapy depends on age at diagnosis, urinary proteinuria, grade EPZ004777 concentration of hematuria, and pathological grade [2]; namely, young age and the absence of hematuria are associated with resistance to TSP. Recently, Ieiri et al. [6] also pointed out that higher age has a favorable impact on the CR rate after TSP. With regards to hematuria, the present study demonstrated that the CR rate in patients with no hematuria (14 out of 292 IgA nephropathy patients) is only 28.6 % compared to 59.6, 56.8, and 56.1 % in patients with 1+, 2+, and 3+ hematuria,

respectively. Extensive review of the literature on the relationship between TSP and hematuria GSK1838705A revealed no studies except for our previous report [2]. IgA nephropathy patients without hematuria may have nephrosclerosis or hereditary G protein-coupled receptor kinase nephritis with concomitant

glomerular IgA deposition, because 4 % of normal persons without urinary abnormalities are reported to have glomerular IgA deposition on postmortem examination after accidental death [7]. Concomitant glomerular IgA deposition has been reported in hereditary nephritis, including thin basement membrane disease [8–10], mild Alport syndrome [11], focal segmental glomerulosclerosis [12], and complement factor abnormalities [13]. Moreover, the CR rate in patients without proteinuria (mainly hematuria alone) is relatively low, 60.8 % compared to approximately 73.0 % in patients with 0.3–0.69 g/day of urinary protein. TSP hardly induces CR in these patients of combination with hereditary nephritis and glomerular IgA deposition. We have to pay attention to the diagnostic criteria of IgA nephropathy when patients show no hematuria or no proteinuria because thin basement membrane disease occurs in up to 9 % of the general population according to an analysis of donor kidney grafts [14], and concomitant glomerular IgA deposition is observed in 4 % of normal population [7]. In conclusion, heat maps with the eGFR or pathological grade and daily amount of urinary protein are useful tools for predicting the CR rate of TSP for IgA nephropathy.

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