Abstract
AimsTo evaluate the incidence of GC-DM among patients with immunoglobulin A nephropathy (IgAN) and to confirm the risk factors for the development of GC-DM.MethodsThe medical records of patients with IgAN newly treated with the protocol of tonsillectomy combined with steroid pulse therapy were reviewed. The primary outcome was the development of GC-DM within the hospitalization period and during one year of follow-up.ResultsDuring hospitalization, 19 of the 95 patients developed GC-DM (20.0%), and the patients with GC-DM were significantly older and had a higher rate of family history of diabetes and higher HbA1c levels. The prevalence of hypertension was higher and the eGFR was numerically lower in patients with GC-DM than in those without. Older age (≥45 years) and a family history of diabetes emerged as independent risk factors for the development of GC-DM (odds ratio [OR], 6.3 and 95% confidence interval [CI], 1.6–27.6; OR, 4.4 and 95% CI, 1.2–16.6, respectively). No patients were newly diagnosed with GC-DM during 1-year observation period at out-patient clinic.ConclusionsAmong the patients with IgAN, 20% developed GC-DM during the hospitalization period, confirming the family history of diabetes is clinically necessary before starting GC therapy.
Highlights
Immunoglobulin A nephropathy (IgAN) is the most common primary glomerulonephritis (GN) worldwide [1, 2]
Older age (!45 years) and a family history of diabetes emerged as independent risk factors for the development of GC-induced diabetes mellitus (GC-DM)
Tonsillectomy combined with steroid pulse (TSP) administration may be useful for inducing complete remission in patients with IgAN who have persistent proteinuria, its long-term effectiveness remains uncertain [7, 8]
Summary
Immunoglobulin A nephropathy (IgAN) is the most common primary glomerulonephritis (GN) worldwide [1, 2]. Glucocorticoids (GCs) are an important component of therapy for IgAN, but their use frequently induces adverse effects, GC-induced diabetes mellitus (GC-DM) [9,10,11,12,13], as 2% to 30% of patients treated with GCs develop GC-DM [10, 14]. Some studies have further reported that even low-dose GCs increase the plasma glucose levels or risk of diabetes in patients with inflammatory rheumatologic diseases [22, 23]. Because DM is an important risk factor for end-stage renal disease in patients with IgAN [24], effectiveness of steroid treatment for IgAN may be attenuated by GC-DM. The patients with risk factors could decide whether received steroid therapy or not considering these disadvantages
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