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Use of Corticosteroids in Norwegian Patients with Immunoglobulin a Nephropathy Progressing to End-stage Kidney Disease: a Retrospective Cohort Study

Overview
Journal BMC Nephrol
Publisher Biomed Central
Specialty Nephrology
Date 2024 Jan 29
PMID 38287343
Authors
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Abstract

Background: Despite several clinical trials, the use of corticosteroid therapy for treating immunoglobulin A nephropathy (IgAN) remains controversial. We aimed to describe the use of corticosteroid therapy combined with supportive therapy in Norwegian patients with IgAN who had progressed to end-stage kidney disease.

Methods: We conducted a retrospective cohort study using data from the Norwegian Renal Registry. Overall, 143 patients with primary IgAN who progressed to end-stage kidney disease were divided into two groups: the corticosteroid group, who had been treated with corticosteroids and supportive therapy, and the non-corticosteroid group, which had underwent only supportive therapy. The kidney function, time to end-stage kidney disease, and adverse effects were described. The observation period lasted from the diagnostic kidney biopsy until the initiation of kidney replacement therapy.

Results: Of the 143 included patients, 103 underwent supportive therapy alone, and 40 were treated with corticosteroids. Most patients (94%) were treated with renin-angiotensin-system blockade, and all patients reached end-stage kidney disease after a median of 5 years (interquartile range; 2-9 years). Time from diagnosis until end-stage kidney disease was similar in the two study groups (p = 0.98). During 6 months of corticosteroid therapy, median eGFR declined from 21 (interquartile range; 13-46) mL/min/1.73 m to 20 (interquartile range; 12-40) mL/min/1.73 m, and median proteinuria decreased from 5.5 g/24 h to 3.0 g/24 h. Most patients (87.5%) treated with corticosteroids reported adverse events. In our linear regression analysis investigating the time to ESKD, we found that age (β = -0.079, p = 0.008) and proteinuria at diagnosis (β = -0.50, p = 0.01) exhibited statistically significant associations with a delay in the progression to ESKD.

Conclusions: In this cohort of Norwegian patients with IgAN, corticosteroid therapy did not affect the time from diagnosis until end-stage kidney disease among a cohort of patients who all reached end-stage kidney disease. The treatment was also associated with adverse effects.

Citing Articles

Lifetime progression of IgA nephropathy: a retrospective cohort study with extended long-term follow-up.

Rivedal M, Nordbo O, Haaskjold Y, Bjorneklett R, Knoop T, Eikrem O BMC Nephrol. 2025; 26(1):32.

PMID: 39833715 PMC: 11749578. DOI: 10.1186/s12882-025-03958-y.

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