Kidney Week

Abstract: TH-PO1026

Corticosteroids Improves Renal Survival in Chinese Patients with Early-Stage IgA Nephropathy

Session Information

• Glomerular Diseases: Minimal Change Disease, FSGS, IgAN
  November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

• Pei, Gaiqin, Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China., Chengdu, China

Gaiqin Pei,

• Tang, Yi, West China Hospital of Sichuan University, Chengdu, China

Yi Tang,

• Qin, Wei, West China Hospital of Sichuan University, Chengdu, China

Wei Qin,

Background

The therapy for immunoglobulin A nephropathy(IgAN) patients remains controversial. This study aims to evaluate the effects of corticosteroids and immunosuppressive therapy in Chinese early stage IgAN patients with estimated glomerular filtration rate(eGFR) ≥45mL/min/1.73 m² and mean proteinuria≥1g/24h.

Methods

Patients with biopsy proven IgAN were retrospectively enrolled from 2007 to 2016.Patients were categorized into supportive care (SC),steroids alone(CS),and steroids plus immunosuppressant(IT) groups.Responses to therapy included complete remission(CR), partial remission(PR),no response(NR)and end stage renal disease(ESRD).The renal outcome was defined as a 50% decline in eGFR and/or ESRD.

Results

715 patients(Male 47% and Female 53%)were recruited and followed for a mean of 44.69±24.13 months. The rate of CR was 81.8%, 62.7%, 37% in CS, IT, SC group, respectively. Renal outcomes were remarkably better in CS group(4.6%)compared with SC(14.4%)and IT(11.5%)group(p<0.001). Moreover, 36-month and 80-month renal survival was significantly better in CS group (98.3% and 86.4 %)than in the IT(94.2% and 82.4%)and SC(94.0% and 51.6%)group. Early CKD stage disease presented with better kidney survival(p<0.001). Further analysis for CKD stage 1 patients suggested no difference among 3 groups.In CKD stage 2 patients,CS alone or with IT could improve renal survival rate when compared with SC alone(p<0.001and 0.007). But,no statistical significant difference could be found between CS and IT groups(p=0.219). For CKD stage 3a patients,renal survival rate in 3 groups were poor(p=0.398). Multivariate model showed that hypertension(HR 1.99, 95% CI 1.16-3.42;p=0.012); serum creatinine (HR 1.02, 95%CI 1.00-1.05;p=0.024); E1 lesion(HR 3.10, 95% CI 1.14-8.42;P=0.027) and T1/T2 lesion (HR 3.34, 95% CI 1.98-6.33;P<0.001)remained as independent predictors of renal survival.

Conclusion

The use of corticosteroids in addition to ACEI/ARB significantly improve the short-term renal outcome in early-stage IgAN patients.