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Efficacy of corticosteroids in immunoglobulin A nephropathy with less than 25% crescents

  • Jingjing Chen
  • Hui XuEmail author
  • Zhangzhe Peng
  • Lizhen Lin
  • Cuifang Li
  • Xuejing Zhu
  • Shao LiuEmail author
Original article
  • 32 Downloads

Abstract

Background

Crescent formation in immunoglobulin A nephropathy (IgAN) has been demonstrated to be a risk factor for worse outcomes. For IgAN patients with 0–25% crescentic glomeruli (C1), whether corticosteroids (CS) can improve the prognosis remains unclear. We tried to investigate the need for using CS in IgAN patients with C1 in different proteinuria levels.

Methods

A total of 120 eligible IgAN patients with C1 from two academic medical centers were retrospectively studied, and 57 (47.5%) received CS. Patients were grouped according to with or without CS. The outcomes were the rate of estimated glomerular filtration rate (eGFR) decline (ml/min per 1.73 m2/year) and a composite outcome (50% decrease in eGFR, end stage renal disease (ESRD) or death due to kidney disease). The progression of adverse outcome among them were analyzed in Kaplan–Meier curve. The independent significance of CS on renal outcome or eGFR decline rate were analyzed by multivariable Cox regression or linear regression.

Results

Unadjusted Kaplan–Meier showed that the outcome of treated patients was better than that of the untreated patients. Multiple Cox regression and linear regression analysis found that CS independently protected the renal outcome and decreased the eGFR decline rate. In the subgroup analysis, multivariate linear regression showed that CS decreased the eGFR decline rate both in proteinuria ≥ 1 g/day and < 1 g/day.

Conclusions

CS protected the renal outcome and slowed the eGFR decline rate of IgAN patients with C1, it also decreased the eGFR decline rate even in those with initial proteinuria < 1 g/day.

Keywords

Crescent Immunoglobulin A nephropathy Prognosis Corticosteroids Estimated glomerular filtration rate (eGFR) 

Notes

Acknowledgements

This work was funded by the Natural Science Foundation of Hunan Province, China [Grant number 2018JJ3835].

Compliance with ethical standards

Conflicts of interest

The authors have declared that no conflict of interest exists.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Ethics Committee (Central South University, No. 2018121134) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

10157_2019_1795_MOESM1_ESM.pdf (115 kb)
Supplementary file1 (PDF 115 kb)
10157_2019_1795_MOESM2_ESM.pdf (82 kb)
Supplementary file2 (PDF 81 kb)
10157_2019_1795_MOESM3_ESM.pdf (81 kb)
Supplementary file3 (PDF 80 kb)

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Copyright information

© Japanese Society of Nephrology 2019

Authors and Affiliations

  1. 1.Department of PharmacyXiangya Hospital of Central South UniversityChangshaPeople’s Republic of China
  2. 2.Department of NephrologyXiangya Hospital of Central South UniversityChangshaPeople’s Republic of China
  3. 3.Institute for Rational and Safe Medication PracticesNational Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South UniversityChangshaChina
  4. 4.Department of NutritionXiang’an Hospital of Xiamen UniversityXiamenChina
  5. 5.Department of NephrologyThe Second Xiangya Hospital, Central South UniversityChangshaChina

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