Corticosteroid for IgA Nephropathy: Are They Really Therapeutic?

Abstract

Background: IgA nephropathy (IgAN) is a common chronic glomerular disease that, in most patients, slowly progresses to end-stage kidney disease. The therapy with corticosteroid in IgAN is still a worldwide problem that is confusing the clinicians. Methods: MEDLINE, EMBASE, the Cochrane Library, and article reference lists were searched for randomized controlled trials (RCTs) that compared corticosteroids with placebo and any other non-immunosuppressive agents in treating IgAN. Twelve RCTs involving 1,057 patients were included. Results: Overall, we found that steroids had statistically significant effects in preventing the decline in renal function (relative risk 0.42, 95% CI 0.25–0.71, p < 0.001) and reducing proteinuria (SMD: –0.58 g/day, 95% CI –0.80 to –0.36 g/day) in patients with IgAN. The association between glucocorticoid and risk of kidney outcome was not modified by steroids’ type (prednisone or methylprednisone), dose (≤30 or > 30 mg/day), duration (≤8 or > 8 months), or serum creatinine (< 1.10 or ≥1.10 mg/dL). But steroids increased the risk of side effects such as gastrointestinal and endocrinium symptoms. Conclusion: This study provides the clear beneficial effects of the steroids therapy on the kidney function and proteinuria, although it should be used with caution.

Clinical Significance of Galactose-Deficient IgA1 by KM55 in Patients with IgA Nephropathy

“…IgA nephropathy (IgAN) is the most common primary glomerulonephritis that is used worldwide, especially in Asian countries [1, 2]. Approximately 20–30% of the patients with IgAN will progress to end-stage renal disease within 20 years [3, 4]. However, the diagnosis of IgAN requires a renal biopsy.…”

The effectiveness and safety of corticosteroid therapy for IgA nephropathy with crescents: a prospective, randomized, controlled study

“…It has been suggested that the Pozzi protocol can significantly reduce proteinuria and protect against renal function deterioration in IgAN patients [10,11]. However, the outcomes of glucocorticoid therapy for IgAN remain inconclusive and conflicting [17]. In recent years, large randomized controlled trials (RCTs) on corticosteroid therapy for IgAN patients, such as the STOP trial [18] and the TESTING trial [19], included patients with primary IgAN proteinuria (1.0-3.5 g/24 h) and glomerular filtration rate (eGFR) 20-120 ml/min/1.73m 2 for corticosteroid therapy (0.6-1.0 mg /Kg/d), and the results show that the corticosteroid therapy is beneficial to the alleviation of proteinuria and the protection of the renal function of IgAN patients in the short term, but the server adverse effects of corticosteroid therapy are also noticed.…”

The effectiveness and safety of corticosteroid therapy for IgA nephropathy with crescents: a prospective, randomized, controlled study

“…It has been suggested that the Pozzi protocol can signi cantly reduce proteinuria and protect against renal function deterioration in IgAN patients [10,11]. However, the outcomes of glucocorticoid therapy for IgAN remain inconclusive and con icting [17]. In recent years, large randomized controlled trials (RCTs) on corticosteroid therapy for IgAN patients, such as the STOP trial[18] and the TESTING trial [19], included patients with primary IgAN proteinuria (1.0-3.5g/24h) and glomerular ltration rate (eGFR) 20-120ml/min/1.73m 2 for corticosteroid therapy (0.6-1.0mg /Kg/d), and the results show that the corticosteroid therapy is bene cial to the alleviation of proteinuria and the protection of the renal function of IgAN patients in the short term, but the server adverse effects of corticosteroid therapy are also noticed.…”