Shankar Prasad Nagaraju
*, Sindhura Lakshmi Koulmane Laxminarayana
2, Aswani Srinivas Mareddy
3, Srikanth Prasad
1, Sindhu Kaza
1, Srinivas Shenoy
1, Karan Saraf
1, Dharshan Rangaswamy
1, Ravindra Prabhu Attur
1, Rajeevalochana Parthasarathy
4, Uday Venkat Mateti
5, Vasudeva Guddattu
6, Mahesha Vankalakunti
71 Department of Nephrology, Kasturba Medical College, Manipal University, Manipal, India
2 Department of Pathology, Kasturba Medical College, Manipal University, Manipal, India
3 Department of Nephrology, Guntur Hospital, Guntur, India
4 Department of Nephrology, Madras Medical Mission, Chennai, India
5 Department of Pharmacy Practice, NGSM Institute of Pharmaceutical Sciences, Nitte University, Mangalore, India
6 Department of Statistics, Kasturba Medical College, Manipal University, Manipal, India
7 Department of Pathology, Manipal Hospital, Bangalore, India
Abstract
Background: Current KDIGO guidelines suggest corticosteroids (CS) administration in IgA
nephropathy (IgAN) with persistent proteinuria >1 g/d despite 3-6 months of supportive
care and estimated glomerular filtration rate (eGFR) >50 mL/min/1.73 m2
. The benefits
of CS in patients with eGFR <50 mL/min/1.73 m2
is unclear.
Objectives: To assess the effect of steroids on disease progression and proteinuria in IgAN
patients with eGFR < 50 mL/min/ 1.73m2
compared with >50 mL/min/1.73 m2
.
Patients and Methods: A cohort of biopsy proven primary IgAN diagnosed between March
2010 - February 2015 who received oral CS with minimum follow-up of 6 months were
included. They were categorized into two groups according to their eGFR (group 1 -
eGFR <50 mL/min/1.73 m2
, group 2 - eGFR >50 mL/min/1.73 m2
). The eGFR and urine
protein creatinine ratio (UPCR) were followed up at entry, 6 months, 12 months and at the
end of follow-up. Outcomes studied were change in eGFR, proteinuria and progression to
end-stage renal disease (ESRD).
Results: Out of 44 patients, 23 were in group1 and 21 patients in group 2. At the end of
follow-up, similar reduction of proteinuria (UPCR) was observed in both groups (P=0.62).
However, group 1 had a significant fall in eGFR compared to improvement in group 2
(P=0.004). One in each group has reached CKD stage 5 (P=0.73).
Conclusions: Addition of CS to conservative treatment in IgAN patients with initial
eGFR<50 ml/min/1.73 m2
seems to reduce proteinuria but not beneficial in preventing
progression of disease as compared to patients with higher eGFR (>50 mL/min/1.73 m2
).
Implication for health policy/practice/research/medical education:
The benefit of using steroids in subgroup of IgA nephropathy patients with eGFR<50 ml/min/1.73 m2
is unclear. In this
retrospective study we compared the effect of steroids on disease progression and proteinuria in IgAN patients with eGFR <
50 mL/min/1.73 m2
(group 1) to those with >50 mL/min/1.73 m2
(group 2). Out of 44 patients, 23 were in group1 and 21
patients in group 2. At the end of follow-up, similar reduction of proteinuria (UPCR) was observed in both groups (P=0.62).
But there was a significant fall in eGFR in group 1, whereas group 2 showed improvement (P=0.004). Administration
of corticosteroids (CS) in addition to conservative treatment seems to reduce proteinuria but not beneficial in preventing
progression of disease in IgAN patients with eGFR<50 ml/min/1.73 m2
.
Please cite this paper as: Nagaraju SP, Laxminarayana SLK, Mareddy AS, Prasad S, Kaza S, Shenoy S, et al. Role of corticosteroid
therapy in IgA nephropathy; where do we stand? J Nephropathol. 2017;6(4):368-373. DOI: 10.15171/jnp.2017.61.