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Abstract: TH-PO1040

Corticosteroid Therapy in IgA Nephropathy

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Bagchi, Soumita, All India Institute of Medical Sciences, New Delhi, India
  • Barwad, Adarsh, All India Institute of Medical Sciences, New Delhi, India
  • Yadav, Raj Kanwar, All India Institute of Medical Sciences, New Delhi, India
  • Mahajan, Sandeep, All India Institute of Medical Sciences, New Delhi, India
  • Bhowmik, Dipankar M., All India Institute of Medical Sciences, New Delhi, India
  • Agarwal, Sanjay K., All India Institute of Medical Sciences, New Delhi, India
Background

Corticosteroid therapy is used in patients with IgA nephropathy(IgAN) with persistent proteinuria, but there is a lack of cosensus about its overall benefits. There is a paucity of data about steroid use in Indian patients who have an aggressive clinical course. This study aims to look at the response to steroid therapy in Indian patients with IgAN.

Methods

Patients with biopsy proven primary IgAN treated with oral corticosteroids from 2012 to 2017 with minimum 12 months follow up were included in the study. MEST-C score was assigned as per the Oxford classification to all biopsies. All patients received oral prednisolone 1mg/Kg/day for 8-12weeks followed by gradual tapering over 6-12 months. Complete remission(CR) was defined as 24-hour urine protein of <500 mg/d with stable eGFR and partial remission(PR) was defined as atleast 50% reduction in proteinuria with stable eGFR with a decline of proteinuria to <3.5g/day.

Results

Of the 94 patients included in study, 64.9% were males with mean age of 30.4±11.9 years. Mean proteinuria was 5.2±2.6 g/day and 53.2% had gross or microscopic hematuria. Mean serum creatinine was 1.4±0.6 mg/dl and mean eGFR was 75. 4± 48.1 ml/min/1.73m2. 77.7% patients had received ACEi/ARB before starting steroid therapy. The distribution of MEST lesions were: M1-70(74.5%), E1-7(7.5%), S1-56(59.6%), T1-26(27.7%) lesions and T2-7(7.5%). 9(9.6%) patients had crescents[C1-7(7.5%), C2-2(2.1%)].
42(44.7%) patients responded to steroid therapy (CR-22, PR-20), of whom 7 patients had one steroid responsive relapse during the follow up and three were steroid dependent. On univariate analysis,S1 lesions on biopsy (p=0.011) and eGFR<30ml/min/1.73m2(p=0.056) predicted steroid resistance. Serious adverse effects were seen in 16 (17.0%) patients mainly comprising of infections (13) with 4 patients developing Tuberculosis. One patient died due to pulmonary nocardiosis.

Conclusion

Steroid therapy reduces proteinuria in 44.7% patients with IgAN. However it is associated with serious infectious complications. The presence of S1 lesion and renal dysfunction at baseline predict poor response.