Current treatment status of IgA nephropathy in Japan: a questionnaire survey,Clinical and Experimental Nephrology

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Current treatment status of IgA nephropathy in Japan: a questionnaire survey
Clinical and Experimental Nephrology ( IF 2.2 ) Pub Date : 2023-08-30 , DOI: 10.1007/s10157-023-02396-0
K Matsuzaki ₁ , H Suzuki ₂ , M Kikuchi ₃ , K Koike ₄ , H Komatsu ₅ , K Takahashi ₆ , I Narita ₇ , H Okada ₈ ,

Affiliation

Background

In 2020, the Committee of Clinical Practical Guideline for IgA Nephropathy (IgAN) revised the clinical practice guidelines. Herein, we conducted a questionnaire survey to assess the potential discrepancies between clinical practice guidelines and real-world practice in Japan.

Methods

A web-based survey of members of the Japanese Society of Nephrology was conducted between November 15 and December 28, 2021.

Results

A total of 217 members (internal physicians: 203, pediatricians: 14) responded to the questionnaire. Of these respondents, 94.0% answered that the clinical practice guidelines were referred to “always” or “often.” Approximately 66.4% respondents answered that histological grade (H-Grade) derived from the “Clinical Guidelines for IgA nephropathy in Japan, 3rd version” and the “Oxford classification” were used for pathological classification. Moreover, 73.7% respondents answered that the risk grade (R-grade) derived from the “Clinical Guidelines for IgA nephropathy in Japan, 3rd version” was referred to for risk stratification. The prescription rate of renin–angiotensin system blockers increased based on urinary protein levels (> 1.0 g/day: 88.6%, 0.5–1.0 g/day: 71.0%, < 0.5 g/day: 25.0%). Similarly, the prescription rate of corticosteroids increased according to proteinuria levels (> 1.0 g/day: 77.8%, 0.5–1.0 g/day: 52.8%, < 0.5 g/day: 11.9%). The respondents emphasized on hematuria when using corticosteroids. In cases of hematuria, the indication rate for corticosteroids was higher than in those without hematuria, even if the urinary protein level was 1 g/gCr or less. Few severe infectious diseases or serious deterioration in glycemic control were reported during corticosteroid use.

Conclusion

Our questionnaire survey revealed real-world aspects of IgAN treatment in Japan.

中文翻译：

日本IgA肾病治疗现状：问卷调查

背景

2020年，IgA肾病临床实践指南委员会（IgAN）修订了临床实践指南。在此，我们进行了一项问卷调查，以评估日本临床实践指南与现实世界实践之间的潜在差异。

方法

2021 年 11 月 15 日至 12 月 28 日期间对日本肾病学会会员进行了一项网络调查。

结果

共有 217 名会员（内科医生：203 名，儿科医生：14 名）回答了调查问卷。在这些受访者中，94.0% 的人回答“总是”或“经常”提到临床实践指南。约66.4%的受访者回答采用《日本IgA肾病临床指南第3版》的组织学分级（H-Grade）和《牛津分类》进行病理分类。此外，73.7%的受访者回答，参考《日本IgA肾病临床指南第3版》的风险等级（R级）进行风险分层。肾素-血管紧张素系统阻滞剂的处方率根据尿蛋白水平而增加（> 1.0 g/天：88.6%，0.5-1.0 g/天：71.0%，< 0.5 g/天：25.0%）。同样，皮质类固醇的处方率根据蛋白尿水平而增加（> 1.0 g/天：77.8%，0.5-1.0 g/天：52.8%，< 0.5 g/天：11.9%）。受访者强调使用皮质类固醇时出现血尿。在出现血尿的情况下，即使尿蛋白水平为 1 g/gCr 或更低，皮质类固醇的适应症也高于无血尿的情况。在使用皮质类固醇期间，很少有严重传染病或血糖控制严重恶化的报告。