What is the efficacy of corticosteroids in the treatment of immunoglobulin A (IgA) nephropathy?

Updated: Feb 15, 2018
  • Author: Sohail Abdul Salim, MD, FASN, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

A retrospective study of 1147 patients from the European Validation Study of the Oxford Classification of IgAN (VALIGA) cohort classified according to the Oxford-MEST classification (see Overview/Prognosis) showed a significant reduction in proteinuria, a slower rate of renal function decline, and greater renal survival with corticosteroid therapy. In contrast to KDIGO recommendations, corticosteroids reduced the risk of progression even in patients with an initial estimated GFR≤ 50 mL/min/1.73 m2 and in direct proportion to the extent of proteinuria. Over median follow-up of 4.7 years, the annual decline in renal function with corticosteroid therapy versus no steroid use was 1.0 versus 3.2 mL/min/1.73 m2, respectively (P= 0.004). [30]

In contrast, the TESTING trial (Therapeutic Evaluation of STeroids in IgA Nephropathy Global study) showed that high-dose oral methylprednisone was associated with significantly increased rates of serious adverse outcomes in participants with >1 g/day proteinuria. This trial included patients with GFRs of 20-120 mL/min. The trial was stopped after 1.5 years due to serious adverse events. [31]


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