title: Corticosteroids in IgA Nephropathy: A Retrospective Analysis from the VALIGA Study.
abstract: Current guidelines suggest treatment with corticosteroids (CS) in IgA nephropathy (IgAN) when proteinuria is persistently ≥1 g/d despite 3-6 months of supportive care and when eGFR is >50 ml/min per 1.73 m(2). Whether the benefits of this treatment extend to patients with an eGFR≤50 ml/min per 1.73 m(2), other levels of proteinuria, or different renal pathologic lesions remains unknown. We retrospectively studied 1147 patients with IgAN from the European Validation Study of the Oxford Classification of IgAN (VALIGA) cohort classified according to the Oxford-MEST classification and medication used, with details of duration but not dosing. Overall, 46% of patients received immunosuppression, of which 98% received CS. Treated individuals presented with greater clinical and pathologic risk factors of progression. They also received more antihypertensive medication, and a greater proportion received renin angiotensin system blockade (RASB) compared with individuals without immunosuppressive therapy. Immunosuppression was associated with a significant reduction in proteinuria, a slower rate of renal function decline, and greater renal survival. Using a propensity score, we matched 184 subjects who received CS and RASB to 184 patients with a similar risk profile of progression who received only RASB. Within this group, CS reduced proteinuria and the rate of renal function decline and increased renal survival. These benefits extended to those with an eGFR≤50 ml/min per 1.73 m(2), and the benefits increased proportionally with the level of proteinuria. Thus, CS reduced the risk of progression regardless of initial eGFR and in direct proportion to the extent of proteinuria in this cohort.
authors: Department of Nephrology, First Faculty of Medicine and General University Hospital, Prague, Czech Republic;
authors: Vladimir
authors: V
authors: Tesar
authors: Sacre-Coeur Hospital of Montreal, Montreal, Quebec, Canada;
authors: Stéphan
authors: S
authors: Troyanov
authors: Oxford University Hospitals, Oxford, United Kingdom;
authors: Shubha
authors: S
authors: Bellur
authors: Sacre-Coeur Hospital of Montreal, Montreal, Quebec, Canada;
authors: Jacobien C
authors: JC
authors: Verhave
authors: Imperial College, Hammersmith Hospital, London, United Kingdom;
authors: H Terence
authors: HT
authors: Cook
authors: University Hospitals of Leicester, Leicester, United Kingdom;
authors: John
authors: J
authors: Feehally
authors: Oxford University Hospitals, Oxford, United Kingdom;
authors: Ian S D
authors: IS
authors: Roberts
authors: University Health Network, Toronto General Hospital, Toronto, Canada; and.
authors: Daniel
authors: D
authors: Cattran
authors: Regina Margherita Children's Hospital, Turin, Italy rosanna.coppo@unito.it.
authors: Rosanna
authors: R
authors: Coppo
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D005922:Glomerulonephritis, IGA / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000209:etiology; D012084:Renin-Angiotensin System; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000959:Antihypertensive Agents; D007166:Immunosuppressive Agents
keywords: IgA nephropathy; immunosuppression; pathology; progression of chronic renal failure; proteinuria; risk factors