Introduction:
As yet there is no dramatic treatment method for severe IgA nephropathy, but trying ARB, MRA, complement inhibitors, SGLT2 inhibitors, endothelin inhibitor, Budesonide etc and eventually fall into ESRD. Cell based therapy especially stromal vascular fraction (SVF) is an emerging field in intractable disorders such as RA, ALS, Inflammatory bowel disease, Alzheimer's disease, Parkinson syndrome, Degenerative arthritis, etc, however there was no reports in clinical nephrology except our group. We firstly reported 2 years follow up results of MP( methylprednisolone) pulse and MSC in severe IgAN( 2015,ASN) with promising results. At this time we report longterm follow up results of MP+SVF in severe IgA nephropathy.
Methods:
We selected pathologically severe IgAN into two groups by eGFR more than 45 ml(A)/min and less than 45 ml/min.(B).We tried methylprednisolone (MP) pulse therapy (5 to 17 cycles), One cycle of MP is 20-30mg/kg (max 1.0gm)/for 3 consecutive days. We tried 3 to 17 cycles every 2 weeks depend on the severity of renal pathology, followed by autologous adipose derived SVF/MSC intravenously. Mean cell count was 3x10(7)/injection. Depends on the harvested fat, we tried 2 to 4 times.
Results:
Seven patients were group A. mean age was 60 years old, Mean initial eGFR was 29min,and 37ml/min after 8.1years follow up.
Three patients were goup B. Mean age 30.6years old. Mean initial eGFR before therapy was 106ml/min. after therapy. Mean follow up period was 10.3 years.
Control patient (C) who took only ARB, started hemodialysis in 2 years (Fig.1)
No noticeable side effects were noted after SVF/MSC therapy. Follow up renal biopsy showed disappearance of EDD, reduced mesangial proliferation and restoration of epithelial foot processes and disappearance of IgA deposition by IF microscopy in group A & B (Fig 2 & 3)
Conclusions:
MP pulse therapy followed by autologous adipose derived stem cells (SVF/MSC) might be a jm promising therapeutic regimens in severe IgAN with CKD without significant side-effects although further studies are mandatory.
Correspondence: koreakidney@daum.net +82-10-5266-3766
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.