To explore the clinical efficacy and safety of leflunomide combined with prednisone in the treatment of immunoglobulin A nephropathy.

80 patients with IgA nephropathy were chosen and randomly divided into two groups, 40 cases in each group.The control group was orally given prednisone(initial dose 1mg·kg^-1·d^-1), after 2 months of treatment 5mg/2 weeks reduction, and 10mg/d as maintenance therapy, while the observation group was treated with 20mg/d leflunomide treatment based on the treatment of control group.All the two groups had 3 months as a course of treatment.Before treatment and after treatment, the 24h urinary protein, serum albumin, serum creatinine, glomerular filtration rate, cholesterol, triglycerides, cystatin C levels and urinary vascular cell adhesion molecule-1 after treatment (urinary VCAM-1) and interleukin-18 (IL-8) in the two groups were recorded and compared, as well as the clinical efficacy and adverse reactions.

The total effective rate in the observation group was 92.5%, which was significantly higher than 75.0% in the control group (χ²=4.501, P<0.05). After treatment, the serum creatinine, serum albumin, cholesterol, triglycerides, cystatin C, 24h urine protein, glomerular filtration rate and urinary VCAM-1, IL-8 in the two groups were all significantly improved (t≥1.945, all P<0.05). After treatment, the cholesterol and triglycerides in the two groups had no significant differences (t=0.322, 1.307, all P>0.05). After treatment, in the observation group, the serum creatinine, cystatin C, 24h urinary protein excretion, VCAM-1 and IL-8 in urine were significantly lower than those in the control group, while serum albumin and glomerular filtration rate were significantly higher (t≥2.632, all P<0.05). In the observation group, the total effective rate of Ⅳ, Ⅴgrade by Lee classification were significantly higher (χ²=4.269, 4.600, all P<0.05). And in the two groups, the total effective rate of Ⅰ, Ⅱ grade by Lee classification had no statistically significant differences(χ²=0.000, 0.000, all P>0.05). In the observation group, the incidence rate of adverse reaction was 10.0%, that in the control group was 8.6%, there was no statistically significant difference between the two groups(χ²=0.157, P>0.05).

Leflunomide combined with prednisone in the treatment of IgA nephropathy has better clinical efficacy and higher safety, its mechanism may be associated with decreased urinary VCAM-1 and serum IL-18 levels.

Leflunomide; Prednisone; Immunoglobulin A nephropathy; Clinical efficacy