What is the role of corticosteroids and other immunosuppressive agents in the treatment of immunoglobulin A (IgA) nephropathy?

Updated: May 19, 2020
  • Author: Sohail Abdul Salim, MD, FASN, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Some trials of corticosteroid therapy for IgA nephropathy have shown positive outcomes. However, the possible benefit from corticosteroids should be weighed against the risks of immunosuppression for the individual patient.

In general there is no benefit gained by adding corticosteroids to renin-angiotensin blockade when proteinuria < 1 g/day. When proteinuria is 1-3 g/day, steroids can be added, but benefits take 6-8 years to become manifest. If proteinuria is > 3 g/day, the benefit of steroids with renin-angiotensin blockade takes 2-3 years to manifest.

Guidelines for IgA nephropathy from Kidney Disease: Improving Global Outcomes (KDIGO) suggest that a 6-month course of corticosteroid therapy may be given to patients who have persistent proteinuria ≥1 g/d despite 3–6 months of optimized supportive care (including ACEI or ARB treatment and blood pressure control), and a glomerular filtration rate (GFR) > 50 ml/min/1.73m2. [30]  

Corticosteroid regimens studied have included the following [31] :

  • Intravenous methylprednisolone ,1 g/day for 3 consecutive days at months 1,3, and 5; plus oral prednisone for 6 months at 0.5 mg/kg every other day [32]
  • Oral prednisone for 6 months at 1 mg/kg/day for 2 months followed by 0.2 mg/kg/day [29]
  • Oral prednisone for 6-8 months at 0.8-1 mg/kg/day for 2 months, then reduced to 5-10 mg every 2 weeks [33]

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