Kidney Week

Abstract: TH-PO1027

Effect of Corticosteroid Therapy for Patients of IgA Nephropathy with Crescents

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

• Liang, Mengjun, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

Mengjun Liang,

• Zhou, Jiafan, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

Jiafan Zhou,

• Zhang, Xing, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

Xing Zhang,

• Jiang, Zongpei, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

Zongpei Jiang,

Background

Patients with IgA nephropathy (IgAN) presented proteinuria≥1g/d and eGFR≥50ml/min/1.73m² after supportive treatment had been advised 6-month course of corticosteroids therapy. Update of Oxford classification of IgAN had recommended crescents be added to the MEST score for they were predictive of outcome. Whether we should take some more positive therapy for crescents?

Methods

We conducted a single-center, retrospective cohort study enrolling 46 patients from 2017.01 to 2018.06, diagnosed with IgAN by renal biopsy. Eligible patients had proteinuria of 0.5~3.5g/d, eGFR≥30ml/min/1.73m² and crescent proportion＜50%. Patients were divided into two groups, one for classical steroid treatment (intravenous methylprednisolone 0.25g/d for 3 days at the beginning of months 1, 3 and 5, plus oral prednisone 0.5 mg/kg/d for 6 months, called 1-3-5 Group) and the other assigned an optimized steroid therapy (intravenous methylprednisolone 0.25g/d for 3 days at the beginning of months 1, 2 and 3, plus oral prednisone as above, called 1-2-3 Group). The primary endpoint was remission of proteinuria, secondary endpoint was deterioration in renal function.

Results

There were 23 patients in each group and no significant differences in age, gentle, baseline proteinuria and eGFR between the two groups, except for the proportion of crescents (for Oxford C1 and C2: 52.5% and 13% in 1-3-5 Group vs. 95.7% and 4.3% in 1-2-3 Group respectively, p=0.001). After 6 months therapy, proteinuria in 1-3-5 Group was 0.5(0.2,0.8)g/d (vs. 1.2(0.8,2.6)g/d at baseline, p＜0.001) and that in 1-2-3 Group was 0.3(0.2,0.6)g/d (vs. 1.5(0.7,2.6)g/d at baseline, p＜0.001). 78.3% of patients in 1-3-5 Group had got remission of proteinuria，while 95.7% in 1-2-3 Group (p=0.187). The 6th month eGFR in 1-3-5 Group was 80.7(59.8,116.2)ml/min/1.73m² (vs. 77.5(54.8,104.6)ml/min/1.73m² at baseline, p=0.212), while that in 1-2-3 Group was 97.8(68.6,130.9)ml/min/1.73m² (vs. 79.5(52.9,108.7)ml/min/1.73m² at baseline, p=0.002). The slope of eGFR in 1-3-5 Group was 0.7(-1.7,3.3)ml/min/1.73m2/month, while that in 1-2-3 Group was 3(1.2,5.4)ml/min/1.73m2/month, p=0.027. None of the patients had met side effects.

Conclusion

Our preliminary results had indicated that optimized steroid therapy had equal effect on reducing proteinuria but more significant advantage to protect against renal function deterioration in IgAN with crescents.