In addition, the effect of multifactorial intensive therapy on the suppression of nephropathy is VX-770 molecular weight not clear at the advanced stage of overt nephropathy. Bibliography 1. Gaede P, et al. N Engl J Med. 2003;348:383–93. (Level 2)   2. Gaede P, et al. N Engl J Med. 2008;358:580–91. (Level 2)   3. Tu ST, et al. Arch Intern Med. 2010;170:155–61. (Level 4)   Is multifactorial intensive therapy recommended for suppressing the onset of CVD in diabetic nephropathy? Diabetes increases the risk of developing both microvascular complications

and CVD. Many patients who have diabetic nephropathy are complicated with hypertension and dyslipidemia and, therefore, are at an even greater risk of the involvement of CVD. The Steno-2 Study showed the effect of multifactorial intensive Ceritinib concentration therapy, including blood glucose, blood pressure using RAS inhibitors and lipid control on the progression of nephropathy in type 2 diabetic patients with microalbuminuria. Therefore, multifactorial intensive therapy is recommended for suppressing the involvement of CVD

in early diabetic nephropathy; however, it should be noted that this recommendation is based on a small RCT. In addition, the effect of multifactorial intensive therapy on the suppression of CVD is not clear at the advanced stage of overt nephropathy. Bibliography 1. Gaede P, et al. N Engl J Med. 2003;348:383–93. (Level 2)   2. Gaede, P, et al. N Engl J Med. 2008; 58:580–91. (Level 2)   Chapter 10: IgA nephropathy (IgAN) Clinical outcomes 1. Clinical course and long-term outcomes   When IgAN was described by Berger and Hinglais in 1968, its prognosis was thought to be favorable. However, after 10- and 20-year outcomes were reported in many countries, including Japan, and ESKD was shown to occur in about 15 and 40 % of cases, the prognosis could no longer be considered favorable. Among

the results from Japan, Asaba et al. reported ESKD in 31 % of patients after 7 years without treatment. Table 5 shows recent find more reports of renal survival at 10 years in various countries, as summarized by D’Amico. Table 5 Renal survival of IgAN patients in the world Reporter Report year Patient number Average observational period(month) 10-year renal survival (%) Europe  D’Amico G (Italy) 1986 365 79 85  Beukhof et al. (The Netherlands) 1986 75 92 84*  Noel et al. (France) 1987 280 >60 85*  Velo et al. (Spain) 1987 153 >60 81*  Bogenschutz et al. (German) 1990 239 59 81$  Rekola et al. (Sweden) 1990 209 76 83#  Alamartine et al. (France) 1991 282 96 94*  Johnston et al. (UK) 1992 220 65 83#  Payton et al. (UK) 1988 67 – 77*  Manno et al. (Italy)4 2007 437 107 82# Australia  Nicolls et al. 1984 244 60 87#  Ibels et al. 1994 121 107 93* Asia  Woo et al. (Singapore) 1986 151 65 91#  Kusumoto et al. (Japan) 1987 87 114 80*  Katafuchi et al. (Japan) 1994 225 48 74#  Yagame et al. (Japan) 1996 206 110 87#  Koyama et al. (Japan) 1997 448 142 85*  Le et al.