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Corticosteroids could improve the renal outcome of IgA nephropathy with moderate proteinuria

  • Nephrology - Original Paper
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Abstract

Background

The specific treatment regimens of IgA nephropathy (IgAN) patients with moderate proteinuria (1.0–3.5 g/day) remain controversial. The purpose of this study was to explore the optimized therapeutic regimen for IgAN patients through analyzing the clinical data.

Methods

A retrospective study was conducted, 449 patients with biopsy-proven IgAN were enrolled. Patients were divided into three groups according to proteinuria levels: urine protein 1.0–1.5 g/day (UP1, n = 111), urine protein 1.5–2.5 g/day (UP2, n = 213), urine protein 2.5–3.5 g/day (UP3, n = 125). Clinical pathological features, treatment regimens and renal outcome were compared. Responses to therapy included complete remission (CR), partial remission (PR), no response (NR) and end-stage renal disease (ESRD). The composite endpoints of renal outcome were defined as 50% decline in eGFR and/or progressing into end-stage renal disease.

Results

During the average follow-up of 44.27 months, 71 (63.9%), 150 (70.4%) and 68 (54.4%) patients achieved CR + PR among three groups, respectively. Whereas 15 (13.5%), 28 (13.1%) and 39 (31.2%) patients progressed to the primary endpoint (P < 0.001). Patients who received corticosteroids (CS) treatment had better remission rate than those with supportive care (SC) or combined corticosteroid plus immunosuppressant (CS + IT) therapy (P < 0.05). Kaplan–Meier survival analysis revealed that patients received CS and CS + IT treatments had better renal prognosis compared with SC therapy in UP2 and UP3 groups (P < 0.05). However, no statistical difference was found among three treatment regimens in UP1 group (P = 0.358).

Conclusion

Corticosteroids therapy might better improve renal prognosis compared with supportive care alone or corticosteroids plus immunosuppressant in IgAN patients with moderate proteinuria (1.5–3.5 g/day).

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Authors and Affiliations

  1. Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China

    ZhengXia Zhong, Yi Tang, JiaXing Tan, Li Tan, GaiQin Pei & Wei Qin

  2. Division of Nephrology, Department of Medicine, Affiliated Hospital of Zunyi Medical College, Guizhou, China

    ZhengXia Zhong

  3. West China School of Medicine, Sichuan University, Chengdu, Sichuan, China

    JiaXing Tan, Li Tan & GaiQin Pei

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  1. ZhengXia Zhong
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  2. Yi Tang
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  4. Li Tan
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  6. Wei Qin
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Correspondence to Wei Qin.

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The research was in compliance with the Declaration of Helsinki and was approved by the ethical committees of West China Hospital of Sichuan University.

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Zhong, Z., Tang, Y., Tan, J. et al. Corticosteroids could improve the renal outcome of IgA nephropathy with moderate proteinuria. Int Urol Nephrol 53, 121–127 (2021). https://doi.org/10.1007/s11255-020-02644-2

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  • DOI: https://doi.org/10.1007/s11255-020-02644-2

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