Abstract
BackgroundCorticosteroids are preferred to treat patients with active IgA nephropathy (IgAN), and beneficial effects from the short-term use of corticosteroids have been confirmed. However, a large number of patients will progress to end-stage renal disease after a long time follow-up. This study aimed to evaluate kidney disease progression and risk factors on kidney survival in IgAN patients receiving steroids treatment.MethodsTwo hundred biopsy-proven IgAN patients who received corticosteroid therapy were enrolled and followed for a median period of 63.33 months. Risk factors on kidney survival were retrospectively investigated by the Cox proportional hazards model.ResultsOf the two hundred patients, twenty patients showed progression of renal impairment at the end of follow-up. The median and interquartile range values for initial serum creatinine were 89.2 and 68.08–121.35 µmol/L, respectively. Multivariate Cox regression analyses revealed that relapse, non-remission, time-averaged eGFR (TA-eGFR), and time-averaged serum albumin (TA-ALB) were independently associated with the kidney progression. Those with TA-ALB levels <35 g/L and TA-eGFR levels <60 mL/min/1.73 m2 were less likely to recover from kidney progression. Patients were more likely to show kidney function deterioration, when they had non-remission or relapse after corticosteroids treatment.ConclusionThis study demonstrated that relapse, non-remission, TA-eGFR, and TA-ALB could serve as independent predictors of long term prognosis of IgAN patients receiving corticosteroid therapy.
Highlights
Corticosteroids are preferred to treat patients with active IgA nephropathy (IgAN), and beneficial effects from the short-term use of corticosteroids have been confirmed
Kidney disease: improving global outcomes (KDIGO) clinical practice guideline for glomerulonephritis suggest that patients with persistent proteinuria >1 g/day, despite 3–6 months of optimized supportive care [including angiotensin converting enzyme inhibitor (ACE-I) or angiotensin II receptor blocker (ARB) and blood pressure control], and GFR >50 mL/min per 1.73 m2, receive a 6-month course of corticosteroid therapy [12]
randomized control trial studies (RCTs) studies have confirmed that 50% increase in plasma creatinine from baseline occurred in about 10% of IgAN patients within 4–5 years of starting steroids treatment [10, 27, 28]
Summary
Corticosteroids are preferred to treat patients with active IgA nephropathy (IgAN), and beneficial effects from the short-term use of corticosteroids have been confirmed. A large number of patients will progress to end-stage renal disease after a long time follow-up. This study aimed to evaluate kidney disease progression and risk factors on kidney survival in IgAN patients receiving steroids treatment. IgA nephropathy (IgAN) is the most commonly occurring glomerulopathy and very likely progresses to end-stage renal disease (ESRD) worldwide [1–4]. There has been widespread interest in corticosteroid therapy for IgAN. Kidney disease: improving global outcomes (KDIGO) clinical practice guideline for glomerulonephritis suggest that patients with persistent proteinuria >1 g/day, despite 3–6 months of optimized supportive care [including angiotensin converting enzyme inhibitor (ACE-I) or angiotensin II receptor blocker (ARB) and blood pressure control], and GFR >50 mL/min per 1.73 m2, receive a 6-month course of corticosteroid therapy [12]
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