Role of corticosteroid therapy in IgA nephropathy; where do we stand?

Shankar Prasad Nagaraju, Sindhura Lakshmi Koulmane Laxminarayana, Aswani Srinivas Mareddy, Srikanth Prasad, Sindhu Kaza, Srinivas Shenoy, Karan Saraf, Dharshan Rangaswamy, Ravindra Prabhu Attur, Rajeevalochana Parthasarathy, Uday Venkat Mateti, Vasudeva Guddattu, Mahesha Vankalakunti

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Abstract

Background: Current KDIGO guidelines suggest corticosteroids (CS) administration in IgA nephropathy (IgAN) with persistent proteinuria >1 g/d despite 3-6 months of supportive care and estimated glomerular filtration rate (eGFR) >50 mL/min/1.73 m2. The benefits of CS in patients with eGFR <50 mL/min/1.73 m2 is unclear. Objectives: To assess the effect of steroids on disease progression and proteinuria in IgAN patients with eGFR < 50 mL/min/ 1.73m2 compared with >50 mL/min/1.73 m2. Patients and Methods: A cohort of biopsy proven primary IgAN diagnosed between March 2010 - February 2015 who received oral CS with minimum follow-up of 6 months were included. They were categorized into two groups according to their eGFR (group 1 -eGFR <50 mL/min/1.73 m2, group 2 - eGFR >50 mL/min/1.73 m2). The eGFR and urine protein creatinine ratio (UPCR) were followed up at entry, 6 months, 12 months and at the end of follow-up. Outcomes studied were change in eGFR, proteinuria and progression to end-stage renal disease (ESRD). Results: Out of 44 patients, 23 were in group1 and 21 patients in group 2. At the end of follow-up, similar reduction of proteinuria (UPCR) was observed in both groups (P = 0.62). However, group 1 had a significant fall in eGFR compared to improvement in group 2 (P = 0.004). One in each group has reached CKD stage 5 (P = 0.73). Conclusions: Addition of CS to conservative treatment in IgAN patients with initial eGFR<50 ml/min/1.73 m2 seems to reduce proteinuria but not beneficial in preventing progression of disease as compared to patients with higher eGFR (>50 mL/min/1.73 m2).

Original languageEnglish
Pages (from-to)368-373
Number of pages6
JournalJournal of Nephropathology
Volume6
Issue number4
DOIs
Publication statusPublished - 01-01-2017

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All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Nagaraju, S. P., Laxminarayana, S. L. K., Mareddy, A. S., Prasad, S., Kaza, S., Shenoy, S., Saraf, K., Rangaswamy, D., Attur, R. P., Parthasarathy, R., Mateti, U. V., Guddattu, V., & Vankalakunti, M. (2017). Role of corticosteroid therapy in IgA nephropathy; where do we stand? Journal of Nephropathology, 6(4), 368-373. https://doi.org/10.15171/jnp.2017.61