Abstract
BackgroundStudies have shown that steroids can improve kidney survival and decrease the risk of proteinuria in patients with Immunoglobulin A nephropathy, but the overall benefit of steroids in the treatment of Immunoglobulin A nephropathy remains controversial. The aim of this study was to evaluate the benefits and risks of steroids for renal survival in adults with Immunoglobulin A nephropathy.Methodology and Principal FindingsWe searched the Cochrane Renal Group Specialized Register, Cochrane Controlled Trial Registry, MEDLINE and EMBASE databases. All eligible studies were measuring at least one of the following outcomes: end-stage renal failure, doubling of serum creatinine and urinary protein excretion. Fifteen relevant trials (n = 1542) that met our inclusion criteria were identified. In a pooled analysis, steroid therapy was associated with statistically significant reduction of the risk in end-stage renal failure (RR: 0.46, 95% CI: 0.27 to 0.79), doubling of serum creatinine (RR = 0.34, 95%CI = 0.15 to 0.77) and reduced urinary protein excretion (MD = −0.47g/day, 95%CI = −0.64 to −0.31).Conclusions/SignificanceWe identified that steroid therapy was associated with a decrease of proteinuria and with a statistically significant reduction of the risk in end-stage renal failure. Moreover, subgroup analysis also suggested that long-term steroid therapy had a higher efficiency than standard and short term therapy.
Highlights
Immunoglobulin A (IgA) nephropathy or Berger’s disease is the most common form of primary glomerulonephritis worldwide [1,2,3,4,5]
Conclusions/Significance: We identified that steroid therapy was associated with a decrease of proteinuria and with a statistically significant reduction of the risk in end-stage renal failure
We identified 1,378 articles from our initial electronic search, of which 1,263 were excluded during an initial review, we retrieved the full text for the remained 115 articles, and 15 clinical trials met the inclusion criteria (Figure 1): they contributed to the study of 1,542 patients with IgA nephropathy in this systematic review and meta-analysis
Summary
Immunoglobulin A (IgA) nephropathy or Berger’s disease is the most common form of primary glomerulonephritis worldwide [1,2,3,4,5]. It is one of the major factors leading to end stage renal failure. About 15–20% of patients with apparent onset IgA nephropathy will develop end stage renal failure within 10 years, and 30–40% within 20 years [6,7,8]. Episodic macroscopic hematuria has been reported as the most common clinical manifestation (40–50% of cases) of IgA nephropathy patients, especially in the second and third decades of life [12]. The aim of this study was to evaluate the benefits and risks of steroids for renal survival in adults with Immunoglobulin A nephropathy
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