Corticosteroid effectiveness in IgA nephropathy: long-term results of a randomized, controlled trial.

Abstract

Proteinuria plays a causal role in the progression of IgA nephropathy (IgAN). A previous controlled trial showed that steroids are effective in reducing proteinuria and preserving renal function in patients with IgAN. The objective of this study was to evaluate the long-term effectiveness of steroids in IgAN, examine the trend of proteinuria during follow-up (starting from the hypothesis that the degree of reduction in proteinuria may influence IgAN outcome), and evaluate how histologic scores can influence steroid response. A secondary analysis of a multicenter, randomized, controlled trial of 86 adult IgAN patients who were receiving supportive therapy or intravenous methylprednisolone plus oral prednisone for 6 mo was conducted. Ten-year renal survival was significantly better in the steroid than in the control group (97% versus 53%; log rank test P = 0.0003). In the 72 patients who did not reach the end point (doubling in baseline serum creatinine), median proteinuria significantly decreased (1.9 g/24 h at baseline, 1.1 g/24 h after 6 mo, and 0.6 g/24 h after a median of 7 yr). In the 14 progressive patients, proteinuria increased from a median of 1.7 g/24 h at baseline to 2.0 g/24 h after 6 mo and 3.3 g/24 h after a median of 5 yr. Steroids were effective in every histologic class. Cox multivariate regression analyses showed that, in addition to steroids, a low baseline histologic score, a reduction in proteinuria after 6 mo, and no increase in proteinuria during follow-up all were independent predictors of a beneficial outcome. Steroids significantly reduce proteinuria and protect against renal function deterioration in IgAN. The histologic picture and proteinuria during early and late follow-up improve the prediction of outcome, but considerable variability remains outside the model.

• Authors: Claudio Pozzi, Simeone Andrulli, Lucia Del Vecchio, Patrizia Melis, Giovanni B Fogazzi, Paolo Altieri, Claudio Ponticelli, Francesco Locatelli
• Journal: Journal of the American Society of Nephrology : JASN (J Am Soc Nephrol) Vol. 15 Issue 1 Pg. 157-63 (Jan 2004) ISSN: 1046-6673 [Print] United States
• PMID: 14694168 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Randomized Controlled Trial)

Chemical References

• Adrenal Cortex Hormones
• Angiotensin-Converting Enzyme Inhibitors

Topics

• Adrenal Cortex Hormones (therapeutic use)
• Angiotensin-Converting Enzyme Inhibitors (therapeutic use)
• Disease Progression
• Female
• Follow-Up Studies
• Glomerulonephritis, IGA (complications, drug therapy, pathology)
• Humans
• Hypertension (complications, drug therapy)
• Male
• Proteinuria (drug therapy, etiology)
• Survival Analysis
• Time Factors