Corticosteroids Pulse Therapy and Oral Corticosteroids Therapy for IgA Nephropathy Patients with Advanced Chronic Kidney Disease: Results of a Multicenter, Large-scale, Long-term Observational Cohort Study

Overview

Journal BMC Nephrol

Publisher Biomed Central

Specialty Nephrology

Date 2018 Sep 8

PMID 30189860

Citations 4

Authors

Ryoya Tsunoda

Joichi Usui

Junichi Hoshino

Takayuki Fujii

Satoshi Suzuki

Kenmei Takaichi

Yoshifumi Ubara

Kunihiro Yamagata

Affiliations

Soon will be listed here.

Abstract

Background: Corticosteroids are widely used to reduce the urine protein levels of patients with immunoglobulin A nephropathy (IgAN). However, their potential preventive effects on end-stage kidney disease (ESKD) are unclear.

Methods: We previously performed a large-scale, long-term multicenter cohort study of patients with biopsy-proven IgAN treated between 1981 and 2013 (n = 1923). Based on the results, we reported that corticosteroids pulse therapy was potentially effective for the treatment of patients with an eGFR ≥30 ml/min/1.73m and a urine protein amount of ≥1 g/gCr. In the present study, we extracted 766 patients with chronic kidney disease (CKD), stage G3-G4 (15 ≤ estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73m) from the same cohort. We divided these patients into a steroid pulse (SP) group, oral steroid (OS) group, and no steroid (NS) group, and analyzed the risk of end-stage kidney disease (ESKD) stratified by eGFR and urine protein (UP) amounts.

Results: Over the median long-term follow-up of 70 ± 115 months, 37.1% of the patients with UP ≥1.0 g/day and 11.2% of the patients with UP < 1.0 g/day reached ESKD. Among the patients with UP ≥1 g/gCr, the SP group showed significantly better renal outcome (p < 0.001) than the OS and NS groups. In patients with UP < 1 g/gCr, there were no differences in renal survival among the treatment groups. These trends appeared even in the CKD stage G4 patients, and were also apparent in patients taking renin-angiotensin system inhibitors. The unprecedented long-term observation period in this study may have been necessary to reveal the favorable effect of corticosteroids on ESKD progression.

Conclusions: In our long-term multicenter study, Corticosteroids pulse therapy was associated with better renal outcomes in IgAN patients with higher UP values, even if their eGFR values were low.

Citing Articles

Comparative analysis between the safety and efficacy of oral corticosteroids versus corticosteroids pulse therapies in IgA nephropathy.

Wang Y, Huang N, Wang Y, Jiang Y, Yimamuyushan A, Xia X Ren Fail. 2023; 45(2):2255683.

PMID: 37724560 PMC: 10512771. DOI: 10.1080/0886022X.2023.2255683.

Immunosuppressants or corticosteroids compared with supportive therapy: a systematic review and meta-analysis on the efficacy and safety for IgA nephropathy treatment.

Feng Q, Xiong Y, Wang J, Feng L Ann Transl Med. 2022; 10(6):355.

PMID: 35433980 PMC: 9011262. DOI: 10.21037/atm-22-1028.

Lipidomics reveals association of circulating lipids with body mass index and outcomes in IgA nephropathy patients.

Deng Y, Wu Q, Chen W, Zhu L, Liu W, Xia F J Mol Cell Biol. 2021; .

PMID: 34272854 PMC: 8697343. DOI: 10.1093/jmcb/mjab040.

Immunopathogenesis of COVID-19 and early immunomodulators.

Lee K, Rhim J, Kang J Clin Exp Pediatr. 2020; 63(7):239-250.

PMID: 32664709 PMC: 7374000. DOI: 10.3345/cep.2020.00759.

References

Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K . Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009; 53(6):982-92. DOI: 10.1053/j.ajkd.2008.12.034. View

Praga M, Gutierrez E, Gonzalez E, Morales E, Hernandez E . Treatment of IgA nephropathy with ACE inhibitors: a randomized and controlled trial. J Am Soc Nephrol. 2003; 14(6):1578-83. DOI: 10.1097/01.asn.0000068460.37369.dc. View

Kobayashi Y, HIKI Y, Fujii K, Kurokawa A, Kamiyama M, TATENO S . Effect of corticosteroids on renal function in progressive IgA nephropathy--long-term follow-up study. Nihon Jinzo Gakkai Shi. 1988; 30(9):1135-42. View

Lv J, Zhang H, Wong M, Jardine M, Hladunewich M, Jha V . Effect of Oral Methylprednisolone on Clinical Outcomes in Patients With IgA Nephropathy: The TESTING Randomized Clinical Trial. JAMA. 2017; 318(5):432-442. PMC: 5817603. DOI: 10.1001/jama.2017.9362. View

Hotta O, Miyazaki M, Furuta T, Tomioka S, Chiba S, Horigome I . Tonsillectomy and steroid pulse therapy significantly impact on clinical remission in patients with IgA nephropathy. Am J Kidney Dis. 2001; 38(4):736-43. DOI: 10.1053/ajkd.2001.27690. View

Rauen T, Eitner F, Fitzner C, Sommerer C, Zeier M, Otte B . Intensive Supportive Care plus Immunosuppression in IgA Nephropathy. N Engl J Med. 2015; 373(23):2225-36. DOI: 10.1056/NEJMoa1415463. View

Moriyama T, Honda K, Nitta K, Yumura W, Nihei H . The effectiveness of steroid therapy for patients with advanced IgA nephropathy and impaired renal function. Clin Exp Nephrol. 2004; 8(3):237-42. DOI: 10.1007/s10157-004-0298-7. View

Pozzi C, Bolasco P, Fogazzi G, Andrulli S, Altieri P, Ponticelli C . Corticosteroids in IgA nephropathy: a randomised controlled trial. Lancet. 1999; 353(9156):883-7. DOI: 10.1016/s0140-6736(98)03563-6. View

Pozzi C, Andrulli S, Del Vecchio L, Melis P, Fogazzi G, Altieri P . Corticosteroid effectiveness in IgA nephropathy: long-term results of a randomized, controlled trial. J Am Soc Nephrol. 2003; 15(1):157-63. DOI: 10.1097/01.asn.0000103869.08096.4f. View

10.

Imbasciati E, GUSMANO R, Edefonti A, Zucchelli P, Pozzi C, Grassi C . Controlled trial of methylprednisolone pulses and low dose oral prednisone for the minimal change nephrotic syndrome. Br Med J (Clin Res Ed). 1985; 291(6505):1305-8. PMC: 1417455. DOI: 10.1136/bmj.291.6505.1305. View

11.

Manno C, Torres D, Rossini M, Pesce F, Schena F . Randomized controlled clinical trial of corticosteroids plus ACE-inhibitors with long-term follow-up in proteinuric IgA nephropathy. Nephrol Dial Transplant. 2009; 24(12):3694-701. DOI: 10.1093/ndt/gfp356. View

12.

Tesar V, Troyanov S, Bellur S, Verhave J, Cook H, Feehally J . Corticosteroids in IgA Nephropathy: A Retrospective Analysis from the VALIGA Study. J Am Soc Nephrol. 2015; 26(9):2248-58. PMC: 4552116. DOI: 10.1681/ASN.2014070697. View

13.

Lv J, Zhang H, Chen Y, Li G, Jiang L, Singh A . Combination therapy of prednisone and ACE inhibitor versus ACE-inhibitor therapy alone in patients with IgA nephropathy: a randomized controlled trial. Am J Kidney Dis. 2008; 53(1):26-32. DOI: 10.1053/j.ajkd.2008.07.029. View

14.

DAmico G . The commonest glomerulonephritis in the world: IgA nephropathy. Q J Med. 1987; 64(245):709-27. View

15.

Kobayashi Y, HIKI Y, Kokubo T, Horii A, TATENO S . Steroid therapy during the early stage of progressive IgA nephropathy. A 10-year follow-up study. Nephron. 1996; 72(2):237-42. DOI: 10.1159/000188848. View

16.

Kobayashi Y, HIKI Y, Fujii K, Kurokawa A, TATENO S . Moderately proteinuric IgA nephropathy: prognostic prediction of individual clinical courses and steroid therapy in progressive cases. Nephron. 1989; 53(3):250-6. DOI: 10.1159/000185753. View

17.

Kawamura T, Yoshimura M, Miyazaki Y, Okamoto H, Kimura K, Hirano K . A multicenter randomized controlled trial of tonsillectomy combined with steroid pulse therapy in patients with immunoglobulin A nephropathy. Nephrol Dial Transplant. 2014; 29(8):1546-53. PMC: 4106640. DOI: 10.1093/ndt/gfu020. View

18.

Hoshino J, Fujii T, Usui J, Fujii T, Ohashi K, Takaichi K . Renal outcome after tonsillectomy plus corticosteroid pulse therapy in patients with immunoglobulin A nephropathy: results of a multicenter cohort study. Clin Exp Nephrol. 2015; 20(4):618-627. DOI: 10.1007/s10157-015-1194-z. View