Current treatment status of IgA nephropathy in Japan: a questionnaire survey

Abstract

Background In 2020, the Committee of Clinical Practical Guideline for IgA Nephropathy (IgAN) revised the clinical practice guidelines. Herein, we conducted a questionnaire survey to assess the potential discrepancies between clinical practice guidelines and real-world practice in Japan. Methods A web-based survey of members of the Japanese Society of Nephrology was conducted between November 15 and December 28, 2021. Results A total of 217 members (internal physicians: 203, pediatricians: 14) responded to the questionnaire. Of these respondents, 94.0% answered that the clinical practice guidelines were referred to “always” or “often.” Approximately 66.4% respondents answered that histological grade (H-Grade) derived from the “Clinical Guidelines for IgA nephropathy in Japan, 3rd version” and the “Oxford classification” were used for pathological classification. Moreover, 73.7% respondents answered that the risk grade (R-grade) derived from the “Clinical Guidelines for IgA nephropathy in Japan, 3rd version” was referred to for risk stratification. The prescription rate of renin–angiotensin system blockers increased based on urinary protein levels (> 1.0 g/day: 88.6%, 0.5–1.0 g/day: 71.0%, < 0.5 g/day: 25.0%). Similarly, the prescription rate of corticosteroids increased according to proteinuria levels (> 1.0 g/day: 77.8%, 0.5–1.0 g/day: 52.8%, < 0.5 g/day: 11.9%). The respondents emphasized on hematuria when using corticosteroids. In cases of hematuria, the indication rate for corticosteroids was higher than in those without hematuria, even if the urinary protein level was 1 g/gCr or less. Few severe infectious diseases or serious deterioration in glycemic control were reported during corticosteroid use. Conclusion Our questionnaire survey revealed real-world aspects of IgAN treatment in Japan.