Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China.
Nephrology (Carlton). 2024 May;29(5):268-277. doi: 10.1111/nep.14269. Epub 2024 Jan 7.
Corticosteroids remain contentious as a therapeutic option for IgA nephropathy. We conducted a retrospective cohort study to explore whether corticosteroid therapy is efficient and safe for IgAN patients with moderate proteinuria.
A total of 336 patients with renal biopsy-confirmed IgAN, estimated glomerular filtration (eGFR) over 15 mL/min/1.73 m and urine protein levels of 0.75-3.5 g/d were enrolled. According to the treatment protocol, we classified the enrolled patients into two groups: one receiving corticosteroids and the other receiving supportive care. Complete remission, partial remission, and no remission were applied to describe the efficacy assessments. The endpoint was defined as a 40% reduction in eGFR, the onset of ESRD, or renal disease-related death.
Clinical and pathological progression risk factors were higher in corticosteroid-treated individuals. Logistic regression analysis revealed that the corticosteroid group was considerably related to a higher remission rate after adjustment for confounding factors. The occurrence of serious adverse events between the two groups was not found to be statistically significantly different. Then, we matched 95 couples of patients with similar baseline levels in both groups by propensity score matching. The results showed that corticosteroid-treated patients showed higher overall and complete remission rates than untreated patients. However, due to the relatively short follow-up period, no significant differences in the incidence of endpoint and survival analyses have been observed thus far.
Corticosteroid therapy may benefit IgAN patients with moderate proteinuria via proteinuria reduction and renal function preservation.
皮质类固醇类药物作为 IgA 肾病的治疗选择仍存在争议。我们进行了一项回顾性队列研究，以探讨皮质类固醇治疗是否对伴有中等量蛋白尿的 IgAN 患者有效且安全。
共纳入 336 例经肾活检证实的 IgAN 患者，估算肾小球滤过率（eGFR）>15ml/min/1.73m2，尿蛋白水平为 0.75-3.5g/d。根据治疗方案，我们将纳入患者分为两组：一组接受皮质类固醇治疗，另一组接受支持性治疗。完全缓解、部分缓解和无缓解用于描述疗效评估。终点定义为 eGFR 下降 40%、进入终末期肾病或与肾脏疾病相关的死亡。
皮质类固醇治疗组的临床和病理进展危险因素更高。逻辑回归分析显示，在调整混杂因素后，皮质类固醇组的缓解率明显更高。两组严重不良事件的发生无统计学差异。然后，我们通过倾向评分匹配将两组中具有相似基线水平的 95 对患者进行匹配。结果表明，皮质类固醇治疗组的总缓解率和完全缓解率均高于未治疗组。然而，由于随访时间相对较短，目前尚未观察到终点和生存分析的发生率存在显著差异。
皮质类固醇治疗可能通过降低蛋白尿和保护肾功能使伴有中等量蛋白尿的 IgAN 患者受益。
