Clinical evaluation of hydroxychloroquine sulfate combined with renin-angiotensin inhibitor on treatment of patients with IgA nephropathy

Yuan Jin; Peng Juan; Zhu Qianfang; Huang Xin; Zhu Zaizhi; Huang Linchuan

doi:10.3969/j.issn.1672-8157.2025.05.019

Abstract：Objective To explore the effect of hydroxychloroquine sulfate combined with renin-angiotensin system inhibitor on treatment of patients with immunoglobulin A(IgA)nephropathy and observe the impact on serum alanine aminotransferase and aspartate aminotransferase.Methods A total of 142 patients with IgA nephropathy(24-hour protein quantification 1-3.5 g)who were treated in the Meishan People's Hospital from July 2022 to October 2023 were recruited as the research subjects and randomly divided into the control group with 71 cases and the treatment group with 71 cases by the random number table method.The control group was given corticosteroid combined with renin-angiotensin system inhibitor,whereas the treatment group was treated with hydroxychloroquine sul-fate combined with renin-angiotensin system inhibitor.The clinical efficacy was compared between the two groups after the treatment for 8 months;the renal protective function indexes(24-hour protein quantification,glomerular filtration rate,serum creatinine,urea nitrogen,albumin,blood potassium,glucose),liver function indexes(alanine aminotransferase,aspartate aminotransferase)and blood routine indicators(white blood cells,platelets)were observed and compared between the two groups before the treatment and after the treatment for 8 months.The adverse drug events in the two groups were recorded.Results The total effective rate of clinical treatment was 83.10%(59/71)in the control group,and 92.96%(66/71)in the treatment group,and there was no statistically significant difference(χ2=3.274,P=0.070).The levels of glomerular filtration rate,albumin and serum potassium of the two groups were respectively(81.20±10.13)mL·min-1·(1.73 m2)-1,(79.42±10.22)mL·min-1·(1.73 m2)-1;(39.88±4.24)g·L-1,(39.16±5.11)g·L-1;(4.34±0.57)mmol·L-1 and(4.29±0.53)mmol·L-1 after the treatment for 8 months,higher than those before the treatment;there were no significant differences in the above indexes between the two groups(t=1.042,0.914,0.541,all P>0.05).The 24-hour urine protein quantification,serum creati-nine and blood urea nitrogen of the two groups were respectively(0.80±0.22)g·d-1,(0.76±0.19)g·d-1,(80.23±14.21)μmol·L-1,(81.20±12.29)μmol·L-1,(5.91±0.62)mmol·L-1 and(6.04±0.83)mmol·L-1 after the treatment for 8 months,lower than those before the treatment,and there were no significant differences between the two groups(t=1.159,0.453,1.057,all P>0.05).In the treatment group,there was no significant difference in the glucose level before the treatment and after the treatment for 8 months((4.27±0.61)mmol·L-1)(t=0.923,P>0.05),and the glucose level of the control group was(6.07±1.12)mmol·L-1 after the treatment,higher than that of the treatment group(t=11.893,P<0.05).After treatment,there were no statistically significant differences in alanine aminotransferase,aspartate aminotrans-ferase,white blood cells,and platelets between the two groups compared to before treatment(t=1.608,1.480,1.427,1.257,1.417,1.216,1.836,1.599,all P>0.05),and there were no statistically significant differences between the groups(t=0.550,0.347,1.101,0.257,all P>0.05).The incidence rate of adverse drug events was 8.45%(6/71)in the treatment group,lower than 21.13%(15/71)in the control group(χ2=4.383,P=0.036).Conclusion Both hydroxychloroquine sulfate combined with renin-angiotensin system inhibitor and cor-ticosteroid combined with renin-angiotensin system inhibitor can improve proteinuria in the patients with IgA nephropathy,and there is no significant difference in the curative effect.Hydroxychloroquine has more advantages in reducing adverse drug events.