Re: Regression of IgAN?

July 31, 2004

> The link is:

>

> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?

cmd=Retrieve & db=PubMed & dopt=Abstract & list_uids=21865974

It seems interesting, but I can't access to the link. Maybe you have

put a space that shouldn't. Let's see if we can access now...

July 31, 2004

Well, I don't know. This is the kind of study that can generate a lot of

discussion, and a lot of argument. First of all, it's what is called a

" retrospective study " , which is just about at the lowest rung in terms of

the value of a study. It's not a controlled trial, with a control group that

doesn't get the treatment. Secondly, what studies conclude depends on what

end point they are looking at. Even in this study, there was no regression

of globally sclerosed glomeruli, only some reduction in segmentally

sclerosed glomeruli. It's hard to know what that kind of information means,

if anything, especially when there is no control group to compare it

against. Thirdly, the cases of IgAN that were included in the study seem

relatively mild to begin with: " Mean serum creatinine level was 1.11 +/-

0.35 (SD) mg/dL (range, 0.6 to 1.9 mg/dL) at the time of the first biopsy

and 0.96 +/- 0.24 mg/dL at the time of the second biopsy. "

Why did they select such mild cases? A suspicious mind could conclude that

it's because it would make the results look good, but more likely, it's

because they were trying to show that agressive treatment of mild IgAN might

be worthwhile while it is still mild. What would the long term results be, I

don't know. There have been a number of retrospective and observational

studies out of Japan over the years that have shown some value with

tonsillectomy. Unfortunately, these results never seem to pan out anywhere

else, and tonsillectomy as a treatment for IgAN meets with resistance even

in Japan. Maybe there's something unique about the IgAN among Japanese

people - who knows. We still don't know everything there is to know about

IgAN and the genetics of it.

Please understand that I'm not trying to dismiss this study published in

2002 out of hand, just trying to point out how we have to be careful about

retrospective and observational studies. In medical science, these are

considered initial studies that suggest a possibility and that should then

lead to more controlled studies. Even the people who conduct these studies

look at it in that way, unless they have some commercial interest in mind.

I guess that a person could conclude that tonsillectomy and early prednisone

treatment are harmless enough and that there's nothing to lose by trying it.

When I was a kid, they routinely took out kids' tonsils at the slightest

hint of infection. This was a carry over from the days when there weren't

many ways to treat infection. This practice of considereing tonsillectomy as

almost routine surgery went by the wayside starting more or less in the

1960's, maybe 50's a bit.

By the way, it has always been known that IgAN can go into remission

spontaneously, even without any treatment at all, in some cases. This is

presumably when it's mild and it has not progressed to any significant

degree of chronic renal insufficiency, because the latter is the result of

permanent scarring which cannot be reversed at this time.

I wouldn't presume to tell you what to do or what to think. I would suggest

you discuss it with your nephrologist.

Pierre

Regression of IgAN?

> I was curious if anyone on this board knows of any adults that have

> had their IgAN go away. The reason I ask is that I came across a

> medical study indicating that 35 people with biopsy proven IgAN later

> had their hematuria disappear and most also had the proteinuria

> disappear. Also, repeat biopsy showed that certain types of

> glomerular inflammation were no longer there and, on some patients,

> IgA deposits had even disappeared completely. The 35 underwent " a

> treatment protocol involving high doses of methylprednisolone and

> tonsillectomy. " It doesn't say how many people underwent this

> treatment, but at least 35 apparently had these positive results.

>

> The link is:

>

> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=

> Retrieve & db=PubMed & dopt=Abstract & list_uids=21865974

>

July 31, 2004

You can't access the link because it is broken into two lines in the email.

To access it anyway, first click on the underlined part, which will take you

to the website, and then, copy the second line that isn't underlined in the