Abstract: SA-PO274

Efficacy of Steroid Therapy for IgA Nephropathy

Session Information

Category: Glomerular

  • 1005 Clinical Glomerular Disorders

Authors

  • Nagasawa, Yasuyuki, Hyogo College of Medicine, Nishinomiya, Japan
  • Moriyama, Toshiki, Osaka University Health Care Center, Toyonaka, Japan
  • Isaka, Yoshitaka, Osaka University Graduate School of Medicine, Suita, OSAKA-FU, Japan
  • Nakanishi, Takeshi, Hyogo College of Mediicne, Nishinomiya, Japan
  • Yamamoto, Ryohei, Osaka University Graduate School of Medicine, Suita, OSAKA-FU, Japan
  • Shinzawa, Maki, Osaka University Graduate School of Medicine, Suita, OSAKA-FU, Japan
  • Shoji, Tatsuya, Osaka General Medical Center, Osaka, Japan
  • Nagatoya, Katsuyuki, Osaka Rosai Hospital, Sakai-city, Japan
  • Hayashi, Terumasa, Osaka General Medical Center, Osaka, Japan
  • Hasuike, Yukiko, Hyogo College of Medicine, Nishinomiya, Japan
  • Kuragano, Takahiro, Internal Medicine Division of Kidney and Dialysis, Nishinomiya, Japan
  • Yamauchi, Atsushi, Osaka Rosai Hospital, Sakai-city, Japan
Background

IgA Nephropathy is most common primary glomerular nephritis not only in Asian, but also in Caucasians. Steroid therapy had been established as standard therapy for IgA nephropathy. But, IgA nephropathy patients with low proteinuria and with normal kidney function were known to have good prognosis. In this point, it is not clear that how much proteinuria and how worse eGFR in IgA nephropathy patients required for the steroid therapy. The aim in this study is to evaluate the relationship between eGFR, proteinuria and efficacy of steroid therapy for IgA nephropathy

Methods

Study design. Retrospective cohort study, 882. IgA nephropathy patients at the age more than 18, whose eGFR was more than 15mL/min/1.73m2, who were diagnosed by renal biopsy. Ethical committee in these three hospitals approved for this study. Exposures were eGFR at the renal biopsy, steroid therapy within one year after renal biops. 1.5 time increase of serum creatinine was treated as outcome.

Results

. Multiple Poisson model analysis revealed proteinuria (per 1g/day, IRR 1.40 [95%CI 1.26-1.56]),eGFR (per 10 mL/min/1.73m2, 0.72 [0.63-0.83]),steroid therapy(0.15 [0.03-0.66]) were identified as renal progression factors, and there was significant interaction between steroid therapy*eGFR (interaction P=0.035). There was stronger suppression effect upon renal progression by steroid therapy in the IgA patients whose eGFR were less than 60mL/min/1.73m2, than in the IgA patients whose eGFR were more than 60(mL/min/1.73m2 (Figure 1). There was favorable effect by steroid upon renal progression in the IgA patient whose proteinuria was more than 60mL/min/1.73m2 (Figure 2)

Conclusion

There was no significant effect of steroid therapy in IgA nephropathy patients with less than 60 eGFR and more than 0.5g/day proteinuria at least during observation periods (5.6 years). Steroid therapy is effective for IgA nephropathy patients whose eGFR were less than 60 and proteinuria were more than 0.5g/day.