Exploring the Value of Combining Glucocorticoids with RAS Blockers and Modified Huangqi Chifeng Decoction in the Treatment of Moderate Proteinuria in IgA Nephropathy: A Propensity-Score Matching Study

Abstract

Objective: Utilizing propensity-score matching (PSM) to investigate the efficacy of combining glucocorticoids with Renin-Angiotensin System (RAS) blockers and Modified Huangqi Chifeng Decoction (MHCD) in treating moderate proteinuria in IgA nephropathy. Methods: Patients diagnosed with focal proliferative IgA nephropathy through renal biopsy and treated at the outpatient clinic of Xiyuan Hospital, China Academy of Traditional Chinese Medicine, from October 2012 to September 2022, were retrospectively analyzed. The control group received MHCD + RAS blockers therapy, while the observation group received MHCD + RAS blocker + glucocorticoid therapy. We used the PSM to eliminate the Confounding factors, five covariates such as gender, age, baseline blood pressure, baseline 24h urine protein quantification (24hU-TP), and baseline estimated glomerular filtration rate (eGFR) were selected to be matched 1:1 (with a caliper value of 0.01), and there were 65 cases in each group after matching. Clinical data of patients at 1, 3, and 6 months of treatment were collected and analyzed, and adverse reactions were recorded. 24hU-TP, Serum Creatinine (Scr), Blood Albumin (ALB), and eGFR were selected as the main clinical efficacy evaluation indexes. Results: Compared with the pre-treatment period, 24hU-TP and Scr decreased significantly in the observation group at all time points, ALB level increased significantly at 3 and 6 months of treatment, and eGFR increased at 6 months of treatment (P ＜ 0.05). Compared with the same period in the control group, the decrease in the levels of 24hU-TP and Scr at all time points was more significant in the observation group (P ＜ 0.05), and the elevated levels of eGFR and ALB were more significant in the observation group at 6 months of treatment (P ＜ 0.05). The mean eGFR rate of change (eGFR-Slope) in the observation group was higher than that in the control group after 6 months of treatment(P ＜ 0.05). There was no statistically significant difference in the occurrence of adverse reactions during treatment between the two groups. Conclusions: Combining glucocorticoids with RAS blockers and MHCD can significantly reduce urinary protein in patients with IgA nephropathy, potentially improving renal function and increasing ALB levels, while not increasing the risk of adverse reactions.