title: Corticosteroid therapy in IgA nephropathy.
abstract: The benefits and risks of steroids for the treatment of IgA nephropathy remain uncertain. We systematically searched MEDLINE, EMBASE, and the Cochrane Library for randomized, controlled trials of corticosteroid therapy for IgA nephropathy published between 1966 and March 2011. We identified nine relevant trials that included 536 patients who had urinary protein excretion >1 g/d and normal renal function. Forty-six (8.6%) of these patients developed a kidney failure event, defined as doubling of the serum creatinine/halving of the GFR or ESRD. Overall, steroid therapy was associated with a lower risk for kidney failure (relative risk, 0.32 [95% confidence interval [CI], 0.15-0.67]; P=0.002) and a reduction in proteinuria (weighted mean difference, -0.46 g/d [95% CI, -0.63 to -0.29 g/d]), with no evidence of heterogeneity in these outcomes. Subgroup analysis suggested that the dose modifies the effect of steroids for renal protection (P for heterogeneity=0.030): Relatively high-dose and short-term therapy (prednisone >30 mg/d or high-dose pulse intravenous methylprednisolone with duration ≤1 year) produced significant renal protection, whereas low-dose, long-term steroid use did not. Steroid therapy was associated with a 55% higher risk for adverse events. The quality of included studies was low, however, limiting the generalizability of the results. In conclusion, steroids appear to provide renal protection in patients with IgA nephropathy but increase the risk for adverse events. Reliably defining the efficacy and safety of steroids in IgA nephropathy requires a high-quality trial with a large sample size.
authors.affiliation: Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, No. 8 Xishiku Street, Xicheng District, Beijing, China.
authors.forename: Jicheng
authors.initials: J
authors.lastname: Lv
authors.forename: Damin
authors.initials: D
authors.lastname: Xu
authors.forename: Vlado
authors.initials: V
authors.lastname: Perkovic
authors.forename: Xinxin
authors.initials: X
authors.lastname: Ma
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
authors.forename: Adeera
authors.initials: A
authors.lastname: Levin
authors.forename: Hong
authors.initials: H
authors.lastname: Zhang
authors.forename: Haiyan
authors.initials: H
authors.lastname: Wang
mesh_terms: D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D002681:China; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005922:Glomerulonephritis, IGA / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D007262:Infusions, Intravenous; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000517:prevention & control*; D007677:Kidney Function Tests; D008297:Male; D008775:Methylprednisolone; D011241:Prednisone / Q000627:therapeutic use; D011379:Prognosis; D020551:Pulse Therapy, Drug; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D011241:Prednisone; D008775:Methylprednisolone