Combined Therapy with Azathioprine, Prednisone, and Enalapril in Children with IgAN and IgAVN

Background: The aim of this study was to evaluate the efficacy of 1-year treatment in children with IgAN and IgAVN using azathioprine, prednisone, and enalapril (AZA+PRED+E) combined with a control kidney biopsy. Methods: This study consists of 68 children diagnosed via kidney biopsy with Oxford classification. The study group included 36 children (15 IgAN, 21 IgAVN) treated with AZA+PRED+E (according to the protocol with a control kidney biopsy); and the control group included 32 children (21 IgAN, 11 IgAVN) who were treated with enalapril alone during one year after kidney biopsy. Results: After 1 year of combined therapy, a significant reduction in both proteinuria (proteinuria = 0 in 35 patients from the study group) and hematuria in the study group was found. It was confirmed that the Δ proteinuria between the start and end of treatment in IgAN and IgAVN patients from the study group was significantly higher than the Δ proteinuria between the start and end of treatment in the control IgAN and IgAVN group treated with enalapril (30.7 ± 43.6 vs. 8.7 ± 8.7; p = 0.015; 68.2 ± 58.3 vs. 19.3 ± 20.3; p = 0.008 respectively). In the Oxford classification a high frequency of improvement in E and T in the study group after treatment was observed. Conclusions: Patients with higher proteinuria and a higher MESTC score require consideration of the strategy of immunosuppressive treatment so that therapy with AZA+PRED+E may be used as a personal treatment plan for children with these diseases.