Society Of Nephrology Research Articles

Prescription of GLP-1 receptor agonists and iSGLT2 in geriatrics, is there a risk?

The use of GLP-1 receptor agonists and iSGLT2 is becoming increasingly common, in line with new guidelines issued by the learned societies of cardiology, nephrology and diabetology. However, the enthusiasm aroused by these new drugs needs to be tempered and their use in the very elderly and/or frail needs to be carefully considered by the lack of scientific studies in this population category, , and their prescription requires a comprehensive geriatric assessment before initiating this type of treatment.

Nephrology Nurses: Essential Professionals in Sustainable Kidney Care.

The increasing frequency of extreme climate events underscores the need for urgent action on climate change. The health care system contributes 4.6% of greenhouse gas emissions (GHGs) in Canada; thus, it is a major contributor to the country's carbon footprint. Kidney care in particular can involve high amounts of waste (eg, plastic and consumable waste associated with dialysis, transportation, emissions, energy, and water consumption). Therefore, sustainability initiatives within the health care system, and especially in the context of kidney care, have great potential to make a positive impact on planetary health. Here, we outline ways in which nephrology nurses can expand our duty of care to the environment and incorporate sustainability into our work. A small advisory group of nephrology nurses in partnership with the Canadian Association of Nurses for the Environment (CANE) assessed ways that sustainable practices can be incorporated into nephrology nursing. Drawing on the Planetary Health Care model used by the Canadian Society of Nephrology: Sustainable Nephrology Action Planning (SNAP) committee, we assessed how the model could be adapted in the context of kidney care using 3 main actionable themes in their work: reducing the demand for health services, matching the supply of health services with demand, and reducing emissions from the supply of health services. We also reviewed and selected real-world examples of initiatives pursued by colleagues. Through this established framework, we provide recommendations and case examples for nephrology nurses to expand our duty of care to the environment. We describe nursing-led strategies used in Canada to improve environmental sustainability in kidney programs and consider their applicability to other renal programs. In 1 case example, we show how a simple nurse-led initiative at a single dialysis clinic can lower plastic waste and associated costs by $2042.59 per year. More broadly, we provide recommendations and actions for nephrology nurses to improve environmental sustainability in kidney care. Nurses in Canada have many responsibilities within limited timeframes, making it essential to choose sustainable practices that do not exacerbate burnout and high workloads. For sustainable practices to be successful, nurses must integrate them into their existing workflows.

The use of intravascular contrast media in patients with impaired kidney function - joint clinical practice position statement of the Polish Society of Nephrology and the Polish Medical Society of Radiology.

Radiological procedures utilising intravascular contrast media (ICM) are fundamental to modern medicine, enhancing diagnostics and treatment in diverse medical fields. However, the application of ICM has been constrained in patients with compromised kidney function due to perceived nephrotoxic risks, called contrast-induced nephropathy or contrastinduced acute kidney injury. Historical evidence marked ICM as a possible contributor to kidney damage. This led to restrictive guidelines advocating limited ICM use in patients with impaired renal function, preventing crucial radiographic interventions in patients with acute kidney injury (AKI) and chronic kidney disease. Recent advances challenge these traditional views. In particular, no direct causal relationship has been confirmed between contrast admi-nistration and elevated serum creatinine concentrations in humans. Furthermore, contemporary research models and meta-analyses do not associate AKI with contrast usage. This paper, prepared by a cross-disciplinary team of nephrologists and radiologists, presents updated guidelines for ICM application amid renal function impairments, emphasising the reduced nephrotoxic risks currently understood and loosening the previous restrictive approach in patients with renal dysfunction.

Research Hotspots in Mitochondria-Related Studies for AKI Treatment: A Bibliometric Study.

Acute kidney injury (AKI) is a common clinical critical condition that has become a significant healthcare burden. In recent years, the relationship between AKI and mitochondria has attracted increasing attention. Protecting mitochondria or restoring their function has emerged as a novel therapeutic strategy for alleviating AKI. This study aims to analyze and summarize the current status, research trends, and hotspots in this field, providing references and directions for future research. AKI and mitochondria-related literature from the Web of Science core collection were retrieved and collected. Bibliometric and visualization analyses were conducted using Microsoft Excel 2021, bibliometric tools (VosViewer, Citespace 6.3.R1, and the bibliometrix R package), R 4.3.2, and SCImagoGraphica software. A total of 2433 publications were included in this study. The number of annual publications in this field has increased year by year. China and the United States are the two most productive countries. Central South University is the most influential research institution in terms of research output, and Parikh SM, Schnellmann RG, and Dong Z are the most influential authors in this field. KIDNEY INTERNATIONAL, JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, and AMERICAN JOURNAL OF PHYSIOLOGY-RENAL PHYSIOLOGY are the most influential journals. Initially, the research focused on keywords such as oxidative stress, ischemia-reperfusion injury, apoptosis, inflammation, and autophagy. In recent years, new research hotspots have emerged, including ferroptosis, aging, mitochondrial quality control, messenger RNA, mitochondrial-targeted antioxidants, extracellular vesicles, and nanodrug delivery. Research on the relationship between mitochondria and AKI has broad developing prospects, and targeting mitochondrial regulation will become a focus of future AKI prevention and treatment research.

Impact of Capacity Building in the Organ Donation Activity During an International Society of Nephrology The Transplantation Society Sister Transplant Center (ISN-TTS STC) Partnership.

This article explores the impact of a partnership program involving the International Society of Nephrology-The Transplantation Society, the Southern Philippines Medical Center, and the University of Barcelona. The program included capacity building and partnership with the Donation and Transplant Institute, leading to the creation of 5 Intermediate Transplant Procurement Management courses for Southern Philippines Medical Center's healthcare professionals. The study analyzed organ donation activity and training records from 2016 to 2022, dividing the periods pre- and postSister Transplant Center partnership, and further subdividing to assess the impact of the COVID-19 pandemic. Results showed an increase of 474.39% in donor referrals by 2019, which then dropped significantly during the COVID-19 pandemic. In 2022, a reimplementation of training opportunities led to a 657% increase in referrals. Capacity building through education, training, and partnerships has a direct and positive impact on organ donation activity, even in the face of challenging circumstances like a global pandemic.

Kidney care in patients with cancer: perspectives from the onconephrology committee of the Brazilian Society of Nephrology.

Kidney care in patients with cancer: perspectives from the onconephrology committee of the Brazilian Society of Nephrology.

How to ensure the sustainability of good practices transfer to heterogeneous contexts? Sharing the results of the JADECARE Joint Action

Summary: This workshop presents the general results of the implementation process of JADECARE and explores the key elements to support the sustainability of good practice transfer beyond the Joint Action.
 It presents the JADECARE Sustainability strategy that sets three core elements: policy environment, ownership of sustainability and culture of collaboration and consensus seeking.
 Two Next Adopters (NAs) adopting and transferring good practices will present the results of the implementation of their local good practices and their work to build sustainability beyond JADECARE.
 Background: JADECARE (the Joint Action on digitally enabled integrated person-centred care) contributes to innovative, efficient and sustainable health systems, providing expertise and sharing good practices to assist the Member States in undertaking health system reforms. It enables the participating national authorities and those beyond the Consortium, to benefit from efficient solutions in digitally enabled integrated person-centred care via supporting best practice transfer to 21 other settings of Next Adopters.
 Aim: Share the results of the implementation process of JADECARE and explore the key elements to ensure the sustainability of local good practices beyond the Joint Action.
 Objectives:
 -Share the results of the JADECARE transfer and adoption process
 -Present the JADECARE Sustainability strategy
 -Promote the discussion among attendees to highlight the key elements to ensure sustainability and scale up of local good practices beyond the project
 Target audience: Policy makers, decision makers, health managers, health authorities, health and social care professionals, researchers, academia, health experts, and staff working on implementation of integrated care, digitalization and/or evaluation.
 Facilitators/speakers: Yhasmine Hamu and Ane Fullaondo (Institute for Health Services Research Kronikgune ) will introduce the workshop, present the general implementation results, moderate and facilitate the thematic discussion.
 Jelka Zaletel and Denis Opresnik (NIJZ) will present the JADECARE Sustainability strategy.
 Chiara Ferravante (ARS Tuscany) and Martina Zorko, Karmen Janša (ZZZS) with Jelka Lindič (Slovene Nephrology Society) representing two NAs will expound the results of their transfer and adoption process highlighting the holders of sustainability beyond JADECARE.
 Format: (90’)
 5’-Introduction and workshop objectives – Ane Fullaondo
 10’- JADECARE transfer and adoption general implementation results – Yhasmine Hamu
 15’- JADECARE Sustainability strategy – Jelka Zaletel and Denis Opresnik 
 15’- Implementation of local good practices within JADECARE with a focus on sustainability – Results from two NAs- Chiara Ferravante, Martina Zorko, Karmen Janša and Jelka Lindič
 40’- Thematic discussion. All participants will be divided into two stations where brainstorming about two topics related to “Key elements to ensure the sustainability and scale up of practices beyond a Joint Action” will be facilitated and harmonised by two moderators. After half of the time the groups will exchange the discussion topic.
 5’- Sharing of main conclusions and Take home messages
 Key Learnings/Take away:
 ‒Learnings on the JADECARE transfer and adoption implementation results
 ‒Understanding about the actions undertaken by the NAs for building sustainable local good practices
 ‒Awareness about the challenges related to the sustainability of good practices transfer to heterogeneous contexts

Kidney damage in hypertension disease

Essential hypertension (EH) is the most common cardiovascular disease and the leading cause of chronic kidney disease (CKD) worldwide. The aim of the study was to investigate the frequency and nature of kidney damage in hypertension. 189 patients (69 men and 120 women) with hypertension (stages I, II, and III) aged 43 years and older were examined. The average age of the patients was 61.2 ± 8.7 years. Clinical and biochemical tests were conducted on all patients, including red blood cell indices, C-reactive protein (CRP), lipid profile, fibrinogen, electrolytes, glucose, uric acid, creatinine, and cystatin C. The duration of hypertension was also recorded for each patient. Kidney function was assessed using serum creatinine (CKD-EPI) and cystatin C (F. Houcke). Patients were categorized according to the degree of decrease in glomerular filtration rate (GFR) based on the recommendations of the Russian Nephrology Society. Patients with kidney damage were divided into two groups: Group 1 consisted of patients with hypertension without signs of CKD (GFR calculated by cystatin C ≥ 60 ml/min), while Group 2 consisted of patients with hypertension complicated by CKD. The results showed that hypertension was accompanied by target organ damage in 70.8% of cases. The prevalence of CKD among patients with hypertension was 28.5%. Proteinuria was mainly detected in patients with renal insufficiency. The frequency of GFR categories according to CKD-EPI and F. Houcke formulas was as follows: G1 — 54.4% and 13.7% (p < 0.05); G2 — 35.9% and 57.6% (p < 0.05); G3a — 5.2% and 19.5% (p < 0.05); G3b — 3.1% and 5.2% (p < 0.05); G4 — 0.5% and 3.1% (p < 0.05) and G5 — 0.5% and 0.5%, respectively. There was a strong correlation between GFR and serum creatinine (r = –0.439; p < 0.05) and cystatin C (r = –0.866; p < 0.0001). Patients in Group 2 (hypertension with kidney damage) had significantly higher levels of CRP, low-density lipoprotein cholesterol, cystatin C, and longer duration of hypertension, but lower levels of total calcium than patients in Group 1. In conclusion, CKD was present in 28.5% of patients with hypertension, and proteinuria was mainly detected in patients with renal insufficiency. Serum cystatin C levels most accurately reflect kidney filtration function.

Synopsis of the Korean Society of Nephrology 2023 Practical Recommendations for the Management of Diabetic Kidney Disease

Korea has one of the highest rates of end-stage kidney disease (ESKD) worldwide and nearly half of all new cases are attributed to diabetes. Diabetes represents a critical aspect of chronic kidney disease (CKD)-related mortality that entails substantial treatment costs. Given the profound impact of ESKD, it is imperative to initiate robust initiatives to formulate and implement effective preventive and therapeutic strategies. These strategies should target the prevention of CKD development in individuals with diabetes and decelerate the progression of diabetic kidney disease. Recognizing this challenge, the Korean Society of Nephrology (KSN) has introduced the kidney health plan 2033, a comprehensive endeavor designed to alleviate the burdens associated with CKD and ESKD in Korea. As part of this initiative, KSN has undertaken the development of the KSN 2023 practical recommendations for the management of diabetic kidney disease. The hope is that implementation of this guideline will delay the onset of kidney-related complications in diabetic patients throughout the country.

Global variability of vascular and peritoneal access for chronic dialysis.

Vascular and peritoneal access are essential elements for sustainability of chronic dialysis programs. Data on availability, patterns of use, funding models, and workforce for vascular and peritoneal accesses for dialysis at a global scale is limited. An electronic survey of national leaders of nephrology societies, consumer representative organizations, and policymakers was conducted from July to September 2018. Questions focused on types of accesses used to initiate dialysis, funding for services, and availability of providers for access creation. Data from 167 countries were available. In 31 countries (25% of surveyed countries), >75% of patients initiated haemodialysis (HD) with a temporary catheter. Seven countries (5% of surveyed countries) had >75% of patients initiating HD with arteriovenous fistulas or grafts. Seven countries (5% of surveyed countries) had >75% of their patients starting HD with tunnelled dialysis catheters. 57% of low-income countries (LICs) had >75% of their patients initiating HD with a temporary catheter compared to 5% of high-income countries (HICs). Shortages of surgeons to create vascular access were reported in 91% of LIC compared to 46% in HIC. Approximately 95% of participating countries in the LIC category reported shortages of surgeons for peritoneal dialysis (PD) access compared to 26% in HIC. Public funding was available for central venous catheters, fistula/graft creation, and PD catheter surgery in 57%, 54% and 54% of countries, respectively. There is a substantial variation in the availability, funding, workforce, and utilization of vascular and peritoneal access for dialysis across countries regions, with major gaps in low-income countries.

Optimum Care of AKI Survivors Not Requiring Dialysis after Discharge: An AKINow Recovery Workgroup Report.

AKI survivors experience gaps in care that contribute to worse outcomes, experience, and cost.Challenges to optimal care include issues with information transfer, education, collaborative care, and use of digital health tools.Research is needed to study these challenges and inform optimal use of diagnostic and therapeutic interventions to promote recovery AKI affects one in five hospitalized patients and is associated with poor short-term and long-term clinical and patient-centered outcomes. Among those who survive to discharge, significant gaps in documentation, education, communication, and follow-up have been observed. The American Society of Nephrology established the AKINow taskforce to address these gaps and improve AKI care. The AKINow Recovery workgroup convened two focus groups, one each focused on dialysis-independent and dialysis-requiring AKI, to summarize the key considerations, challenges, and opportunities in the care of AKI survivors. This article highlights the discussion surrounding care of AKI survivors discharged without the need for dialysis. On May 3, 2022, 48 patients and multidisciplinary clinicians from diverse settings were gathered virtually. The agenda included a patient testimonial, plenary sessions, facilitated small group discussions, and debriefing. Core challenges and opportunities for AKI care identified were in the domains of transitions of care, education, collaborative care delivery, diagnostic and therapeutic interventions, and digital health applications. Integrated multispecialty care delivery was identified as one of the greatest challenges to AKI survivor care. Adequate templates for communication and documentation; education of patients, care partners, and clinicians about AKI; and a well-coordinated multidisciplinary posthospital follow-up plan form the basis for a successful care transition at hospital discharge. The AKINow Recovery workgroup concluded that advancements in evidence-based, patient-centered care of AKI survivors are needed to improve health outcomes, care quality, and patient and provider experience. Tools are being developed by the AKINow Recovery workgroup for use at the hospital discharge to facilitate care continuity.

A Canadian Commentary on the NKF-ASN Task Force Recommendations on Reassessing the Inclusion of Race in Diagnosing Kidney Disease

In 2021, a committee was commissioned by the Canadian Society of Nephrology (CSN) to comment on the 2021 National Kidney Foundation (NKF)- American Society of Nephrology (ASN) Task Force recommendations on the use of race in glomerular filtration rate (GFR) estimating equations. The committee met on numerous occasions and agreed on several recommendations. However, the committee did not achieve unanimity, with a minority group disagreeing with the scope of the commentary. As a result, this report presents the viewpoint of the majority members. We endorsed many of the recommendations from the NKF-ASN Task Force, most importantly that race should be removed from the eGFR creatinine-based equation. We recommend an immediate implementation of the new CKD-EPI equation (2021), which does not discriminate among any group while maintaining precision. Additionally, we recommend that Canadian laboratories and provincial kidney organizations advocate for increased testing and access to cystatin C as the combination of cystatin C and creatinine in revised equations leads to more precise estimates. Lastly, we recommend that future research studies evaluating the implementation of the new equations and changes to screening, diagnosis, and management across provincial health programs be prioritized in Canada.

Consensus document on the management of hyperkalemia

Hyperkalaemia is a common electrolyte imbalance with potentially serious short-, medium- and long-term consequences on morbidity and mortality rates and the use of national health service resources. The fact that different medical specialities can manage hyperkalaemia makes it important to have a unified approach, and the recent availability of new specific drug treatments means that the approach needs to be updated. This consensus document from the scientific societies most directly involved in the management of hyperkalaemia (Sociedad Española de Cardiología [Spanish Society of Cardiology], Sociedad Española de Endocrinología y Nutrición [Spanish Society of Endocrinology and Nutrition], Sociedad Española de Medicina Interna [Spanish Society of Internal Medicine], Sociedad Española de Medicina de Urgencias y Emergencias [Spanish Society of Accident and Emergency Medicine] and Sociedad Española de Nefrología [Spanish Society of Nephrology]) first of all reviews basic aspects of potassium balance and blood potassium. Then it goes on to focus on the concept, epidemiology, pathophysiology and diagnostic and therapeutic approaches to hyperkalaemia. The available evidence and the main published studies have been reviewed with the aim of providing a useful tool in the multidisciplinary approach to patients with hyperkalaemia.

Climate Change and Sustainability in Kidney Care in Canada: A Knowledge, Attitudes, and Practices (KAP) Survey by the Canadian Society of Nephrology's Sustainable Nephrology Action Planning Committee

Climate Change and Sustainability in Kidney Care in Canada: A Knowledge, Attitudes, and Practices (KAP) Survey by the Canadian Society of Nephrology's Sustainable Nephrology Action Planning Committee

Assessing the Current Evidence on Environmental Sustainability in Nephrology: Protocol for a Scoping Review by the International Society of Nephrology, Emerging Leaders Program Cohort 2022-2024

Assessing the Current Evidence on Environmental Sustainability in Nephrology: Protocol for a Scoping Review by the International Society of Nephrology, Emerging Leaders Program Cohort 2022-2024

Sustainable Development Goals: Challenges and the Role of the International Society of Nephrology in Improving Global Kidney Health.

The United Nations 2030 agenda for sustainable development includes 17 sustainable development goals (SDGs) that represent a universal call to end poverty and protect the planet, and are intended to guide government and private sector policies for international cooperation and optimal mobilization of resources. At the core of their achievement is reducing mortality by improving the global burden of noncommunicable diseases (NCDs), the leading causes of death and disability worldwide. CKD is the only NCD with a consistently rising age-adjusted mortality rate and is rising steadily up the list of the causes of lives lost globally. Kidney disease is strongly affected by social determinants of health, with a strong interplay between CKD incidence and progression and other NCDs and SDGs. Tackling the shared CKD and NCD risk factors will help with progress toward the SDGs and vice versa . Challenges to global kidney health include both preexisting socioeconomic factors and natural and human-induced disasters, many of which are intended to be addressed through actions proposed in the sustainable development agenda. Opportunities to address these challenges include public health policies focused on integrated kidney care, kidney disease surveillance, building strategic partnerships, building workforce capacity, harnessing technology and virtual platforms, advocacy/public awareness campaigns, translational and implementation research, and environmentally sustainable kidney care.

Pruritus associated with chronic kidney disease in hemodialysis patients: a survey in French nephrologists

Chronic kidney disease-associated pruritus (CKD-aP) is common in hemodialysis patients and severely impairs their quality of life, but the practices of nephrologists remain poorly known. The objective of this on-line survey was to describe the management of CKD-aP in French nephrologists affiliated with the French-speaking Society of Nephrology, Dialysis and Transplantation (SFNDT) and involved in hemodialysis. In total, 122 questionnaires were completed and 100 were usable. Nephrologists reported they personally managed a median of 52 patients; they estimated that the CKD-aP prevalence in their hemodialysis patients was a median of 10% (IQR, 6.3-17.2); 6% of nephrologists reported not following any patient with CKD-aP. In case of CKD-aP, the first-intention intervention was the evaluation of phosphocalcic metabolism (53.5%) and verification of dialysis adequacy (52%). For moderate-to-severe CKD-aP, the first-line prescription was topical therapy (71.3%), antihistamine (23.2%) and membrane change (15.9%). Patients were referred to a dermatologist mainly in case of treatment failure (86.9%) or scratching lesions (40.4%). Available treatments were considered ineffective for 50.5% of nephrologists, partially effective for 45.5% and effective for only 4%. These results show that according to the opinion of nephrologists, the pruritus prevalence is low in dialysis patients. This is inconsistent with studies based on systematic patient interviews, thus suggesting that pruritus is a symptom overlooked by nephrologists. In the context of the arrival of a new drug for pruritus, patients should be more questioned about this symptom in order to propose this treatment.

Cost-effectiveness analysis of cinacalcet vs. paricalcitol in the treatment of hyperparathyroidism secondary to chronic kidney disease.

For the reduction of PTH levels, two classes of drugs are available in the Brazilian market: non-selective and selective vitamin D receptor activators and calcimimetics. Among the mentioned drugs, the SUS provides oral calcitriol, paricalcitol and cinacalcet. Develop cost-effectiveness (CE) and budgetary impact (BI) analysis of cinacalcet versus paricalcitol for patients on dialysis with SHPT, from the perspective of SUS. A decision tree model was constructed for CE analysis, which considered the outcome of avoided parathyroidectomy and a time horizon of 1 year. As for the BI analysis, two scenarios were considered, one of which was measured demand and other epidemiological, based on data from the Brazilian Society of Nephrology (BSN). The CE analysis showed that the use of cinacalcet results in one-off savings of R$1,394.64 per year and an incremental effectiveness of 0.08, in relation to avoided parathyroidectomy. The incremental CE ratio (ICER) was - R$ 17,653.67 per avoided parathyroidectomy for cinacalcet, as it was more effective and cheaper compared to paricalcitol. As for the BI analysis, it was estimated that the incremental BI with the expansion of the use of cinacalcet in the SUS will be between - R$ 1,640,864.62 and R$ 166,368.50 in the first year, considering the main and the epidemiological scenarios. At the end of 5 years after the expansion of use, an BI was estimated between - R$ 10,740,743.86 and - R$ 1,191,339.37; considering the same scenarios. Cinacalcet was dominant to avoid parathyroidectomies, being cost-effective.

Adverse renal effects of check-point inhibitors (ICI) in cancer patients: Recommendations of the Onco-nephrology Working Group of the Spanish Society of Nephrology

The most widely used approach in the immunotherapy treatment of cancer is the administration of monoclonal antibodies directed against regulatory molecules of immune control that inhibit the activation of T cells, the so-called check point inhibitors (ICI). ICI nephrotoxicity epidemiology and pathology; its diagnosis with or without kidney biopsy; the type and duration of treatment; the possibility of rechallenging after kidney damage; and its indication in patients with cancer and renal transplantation are certainly controversial. In the absence of definitive studies, this document is intended to specify some recommendations agreed by the group of Onconephrology experts of the Spanish Society of Nephrology in those areas related to ICI nephrotoxicity, in order to help decision-making in daily clinical practice in Onconephrology consultations.

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

BackgroundIn 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.MethodsA web-based survey of members of the Japanese Society of Nephrology was conducted between November 15 and December 28, 2021.ResultsA 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.ConclusionOur questionnaire survey revealed real-world aspects of IgAN treatment in Japan.